Characteristics and incidences of pediatric Crohn's disease in the decades before and after 2000.

OBJECTIVE: The increasing incidence of pediatric Crohn's disease (CD) is well known in Western countries in the last two decades. This study was conducted to delineate the trends of incidence during this period and clinical patterns of pediatric CD in Taiwan. METHODS: All children admitted to National Taiwan University Hospital between 1990 and 2009 who met the Porto Criteria for CD were included. Annual enrollment and clinical characteristics were retrospectively reviewed. The incidence was calculated by dividing the number of index cases by total hospitalized pediatric cases to minimize the bias caused by the growing number of hospitalized patients there. We quoted data and statistics from the Department of Health, Executive Yuan, Taiwan, and Accounting and Statistics, Executive Yuan, Taiwan, to present the social-economic changes in Taiwan in the recent decades. RESULTS: The cumulative hospital-based incidence of CD rose from 13.2 per 100,000 to 25.4 per 100,000 children admitted to this hospital in the past two decades. The median age of diagnosis in the first decade of this study was less than that of the second decade. The other study parameters, including gender, disease activity at diagnosis, duration from disease onset to diagnosis, anatomic location and disease behavior, and symptoms at diagnosis, were not different. CONCLUSIONS: This study showed that the hospital-based incidence of pediatric CD has been increasing in Taiwan in recent decades. Factors contributing to such an increase could be physicians' awareness of the disease, easier access to health care, and environmental factors.

Early development of acute myeloid leukemia following treatment of osteosarcoma: a case report and review of the literature.

We report a case of treatment-related acute myeloid leukemia (t-AML) in a 16-year-old male following treatment for osteosarcoma (OS). He had been treated with a protocol comprising neoadjuvant chemotherapy, definitive surgery with wide excision and adjuvant chemotherapy for OS. Four months after completion of the treatment, a routine hemogram showed hyperleukocytosis with 90% blasts. Bone marrow aspirate and a chromosomal analysis disclosed acute myeloid leukemia (AML), M5b with 46, XY, t(11;19)(q23;p13.3). The t-AML was characterized by early development (just 4 months after completion of chemotherapy for OS) and generalized leukemia cutis. The patient received an alkylating agent (ifosfamide) and DNA topoisomerase II-targeted drugs (etoposide and doxorubicin). In terms of latency, cytogenetics, and presentation, DNA topoisomerase II-targeted drug-related leukemia seemed likely for this patient. Clinically, his leukemia cutis had developed during a nadir in white blood cell count after the first induction of chemotherapy for AML. The rapid progression and its refractoriness to chemotherapy were poor prognostic signs.

Postoperative intussusception in children with enterostomy.

Postoperative intussusception (POI) is an uncommon but important cause of postoperative intestinal obstruction. We describe three cases of intussusception, which developed after major abdominal surgery. Two of the patients were premature newborns whose conditions were complicated by necrotizing enterocolitis and accepted ostomy. The other case involved a patient with Hirschsprung's disease who had had a previous colostomy and accepted Duhamel pull through procedure. Postoperative intussusception is a rare complication of pediatric abdominal surgery and may occur in premature infants. The ostomy may be the predisposing factor of these patients.

Risk factors of meconium aspiration syndrome developing into persistent pulmonary hypertension of newborn.

Clinical experience indicates that persistent pulmonary hypertension of the newborn (PPHN) is one of the major causes of death in infants with meconium aspiration syndrome (MAS). We aimed to investigate the risk factors associated with MAS which lead to PPHN in order to search for ways to reduce the mortality associated with MAS. From 1995 to 2003, we conducted a retrospective study of infants with MAS at the China Medical University Hospital. We compared the risk factors associated with MAS, including pattern of fetal heart beat, mode of delivery, apgar score, sex, gestational age, birth body weight, in born or out born infants, resuscitation before admission, first pH at admission, asphyxia, surfactant usage, pneumothorax, pulmonary hemorrhage and shock before the diagnosis of PPHN between PPHN and non PPHN infants. During the nine-year study, 362 infants with MAS were enrolled. There were 64 infants with (17.7%) PPHN and 298 infants without PPHN. According to univariant analysis, the significant risk factors associated with MAS which lead to PPHN were out born infant (p=0.007), change of fetal heart beat pattern (p=0.0001), resuscitation before admission (p=0.0001), low pH (p=0.002), asphyxia (p<0.0001), shock (p<0.0001), pneumothorax (p=0.0004), and pulmonary hemorrhage (p<0.0002). Based on the results of logistic regression analysis, the risk factors were pneumothorax (p=0.04, odds ratio: 2.34), change of fetal heart beat pattern (p=0.02, odds ratio: 2.37) and asphyxia (p=0.001, odds ratio: 5.48). We conclude that pneumothorax, change of fetal heart beat pattern and asphyxia are the most important risk factors associated with MAS which lead to the development of PPHN. Avoidance of asphyxia and pneumothorax might be the key to reduce the incidence of PPNH and mortality rate of MAS.