Publications by authors named "Jin-Bok Hwang"

27 Publications

  • Page 1 of 1

Clonazepam treatment of pathologic aerophagia in children with mental retardation.

Pediatr Gastroenterol Hepatol Nutr 2014 Dec 31;17(4):209-13. Epub 2014 Dec 31.

Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

Purpose: Pathologic aerophagia (PA) may lead to bowel perforation or volvulus in mentally retarded patients. The authors investigated the effects of clonazepam on the management of PA in children with severe to profound mental retardation (MR).

Methods: This study was undertaken as a retrospective case analysis of 21 PA patients with MR who were followed for over 12 months and diagnosed as having PA. Patients were assigned to two management groups, that is, to a clonazepam randomized open-labeled, treatment group or a reassurance group. The following were recorded and analyzed; age, response, remission rate to clonazepam treatment, and the side effect of clonazepam. It was defined positive response (response+) as being symptom-free for a whole week within 1 month of commencing treatment and remission(+) as being symptom-free for a whole month within 6 months of treatment.

Results: The average age of the 21 PA children with MR was 10 years and 13 patients were female. Symptom duration before diagnosis of PA was 7 months. Clinical features of the clonazepam-trial group (n=11) and the reassurance group (n=10) were non-significantly different. Response(+) was achieved by 2 patients (18.2%) in the clonazepam-trial group and by no patient in the reassurance group. Remission(+) was achieved by 6 patients (54.5%) in the clonazepam-trial group and by one patient (10%) in the reassurance group (p=0.040).

Conclusion: When PA children with MR with severe bowel distention are considered for surgical treatment to prevent acute abdomen, a trial of clonazepam could be recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5223/pghn.2014.17.4.209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291445PMC
December 2014

Is This Symptom Even a Food Allergy?: Clinical Types of Food Protein-induced Enterocolitis Syndrome.

Authors:
Jin-Bok Hwang

Pediatr Gastroenterol Hepatol Nutr 2014 Jun 30;17(2):74-9. Epub 2014 Jun 30.

Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

Food protein-induced enterocolitis syndrome (FPIES) is an under-recognized non-IgE-mediated gastrointestinal food allergy. The diagnosis of FPIES is based on clinical history, sequential symptoms and the timing, after excluding other possible causes. It is definitively diagnosed by an oral food challenge test. Unfortunately, the diagnosis of FPIES is frequently delayed because of non-specific symptoms and insufficient definitive diagnostic biomarkers. FPIES is not well recognized by clinicians; the affected infants are often mismanaged as having viral gastroenteritis, food poisoning, sepsis, or a surgical disease. Familiarity with the clinical features of FPIES and awareness of the indexes of suspicion for FPIES are important to diagnose FPIES. Understanding the recently defined clinical terms and types of FPIES is mandatory to suspect and correctly diagnose FPIES. The aim of this review is to provide a case-driven presentation as a guide of how to recognize the clinical features of FPIES to improve diagnosis and management of patients with FPIES.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5223/pghn.2014.17.2.74DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107223PMC
June 2014

Food protein-induced proctocolitis: Is this allergic disorder a reality or a phantom in neonates?

Korean J Pediatr 2013 Dec 20;56(12):514-8. Epub 2013 Dec 20.

Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea.

The etiology of small and fresh rectal bleeding in neonates who are not sick is usually unknown; the only known cause is food protein-induced proctocolitis (FPIPC). It has been recently reported that FPIPC is a rare cause of rectal bleeding in newborns, and most cases have been proved to be due to idiopathic neonatal transient colitis. A recommended strategy for diagnosing suspected FPIPC in neonates is as follows. During the early stage, the etiology of small and fresh rectal bleeding in an otherwise healthy newborn need not be studied through extensive investigations. In patients showing continued bleeding even after 4 days, sigmoidoscopy and rectal mucosal biopsy may be performed. Even if mucosal histological findings indicate a diagnosis of FPIPC, further oral food elimination and challenge tests must be performed sequentially to confirm FPIPC. Food elimination and challenge tests should be included in the diagnostic criteria of FPIPC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3345/kjp.2013.56.12.514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885785PMC
December 2013

Successful endoscopic submucosal dissection of a giant polyp in a 21-month-old female.

World J Gastroenterol 2014 Jan;20(1):323-5

Eun-Young Jung, Soon-Ok Choi, Department of Pediatric Surgery, Division of Gastroenterology and Hepatology, Keimyung University School of Medicine, Daegu 700-712, South Korea.

Endoscopic submucosal dissection (ESD) is now recognized as the preferred treatment modality for gastrointestinal epithelial lesions. A 21-month-old female was admitted with a giant hyperplastic polyp causing a gastric outlet obstruction. Successful ESD was performed with caution. The post-procedural course was uneventful without a bleeding episode. Although further study of the feasibility of ESD in early children is necessary, ESD could be applied to avoid laparotomy even in young children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3748/wjg.v20.i1.323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886027PMC
January 2014

Epstein-barr virus infection with acute pancreatitis associated with cholestatic hepatitis.

Pediatr Gastroenterol Hepatol Nutr 2013 Mar 31;16(1):61-4. Epub 2013 Mar 31.

Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

Infection-induced acute hepatitis complicated with acute pancreatitis is associated with hepatitis A virus, hepatitis B virus or hepatitis E virus. Although rare, Epstein-Barr virus (EBV) infection should be considered also in the differential diagnosis if the patient has acute hepatitis combined with pancreatitis. We report a case of EBV infection with cholestatic hepatitis and pancreatitis with review of literature. An 11-year-old female was admitted due to 1-day history of abdominal pain and vomiting without any clinical symptoms of infectious mononucleosis. Diagnosis of reactivated EBV infection was made by the positive result of viral capsid antigen (VCA) IgM, VCA IgG, Epstein-Barr nuclear antigen and heterophile antibody test. We performed serologic tests and magnetic resonance cholangiopancreatography to exclude other viral or bacterial infection, autoimmune disorder, and structural problems. The patient's symptoms recovered rapidly and blood chemistry returned to normal with conservative treatment similar to previously reported cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5223/pghn.2013.16.1.61DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746049PMC
March 2013

Acute Pancreatitis Induced by Azathioprine and 6-mercaptopurine Proven by Single and Low Dose Challenge Testing in a Child with Crohn Disease.

Pediatr Gastroenterol Hepatol Nutr 2012 Dec 31;15(4):272-5. Epub 2012 Dec 31.

Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

We report here a case of drug-induced acute pancreatitis proved by elimination and single, low dose challenge test in a child with Crohn disease. A 14-year-old boy with moderate/severe Crohn disease was admitted due to high fever and severe epigastric pain during administration of mesalazine and azathioprine. Blood test and abdominal ultrasonography revealed acute pancreatitis. After discontinuance of the medication and supportive care, the symptoms and laboratory findings improved. A single, low dose challenge test was done to confirm the relationship of the adverse drug reaction and acute pancreatitis, and to discriminate the responsible drug. Azathioprine and 6-mercaptopurine showed positive responses, and mesalazine showed a negative response. We introduce the method of single, low dose challenge test and its interpretation for drug-induced pancreatitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5223/pghn.2012.15.4.272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746057PMC
December 2012

Cytomegalovirus-associated esophageal ulcer in an immunocompetent infant: When should ganciclovir be administered?

Korean J Pediatr 2012 Dec 20;55(12):491-3. Epub 2012 Dec 20.

Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

Cytomegalovirus (CMV)-associated esophageal ulcer is rare in immunocompetent infants. The presence of inclusion bodies and immunohistochemical staining for CMV in biopsy specimens obtained during esophagogastroduodenoscopy (EGD) indicate that such ulcers occur because of CMV infection. A 7-week-old female infant who experienced frequent vomiting and feeding intolerance was diagnosed with a massive CMV-associated ulcer in the distal esophagus. The ulcer improved after conservative treatment using proton-pump inhibitors; however, ganciclovir was not administered. In a follow-up EGD biopsy specimen, no CMV inclusion bodies were present, and immunohistochemical staining results for this virus were negative. The presence of CMV inclusion bodies indicates active viral replication. If persistent inclusion bodies or positive immunohistochemical staining for CMV is observed in follow-up biopsy specimens, ganciclovir may be used to treat CMV-associated esophageal ulcers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3345/kjp.2012.55.12.491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534164PMC
December 2012

The etiology of small and fresh rectal bleeding in not-sick neonates: should we initially suspect food protein-induced proctocolitis?

Eur J Pediatr 2012 Dec 15;171(12):1845-9. Epub 2012 Sep 15.

Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Daegu 700-712, Republic of Korea.

Unlabelled: This study was performed to identify the cause and frequency of food protein-induced proctocolitis (FPIPC) in not-sick neonates with small and fresh rectal bleeding and to verify the effectiveness of oral food elimination and challenge test (ECT) as a diagnostic method of FPIPC. We prospectively analyzed neonates with small and fresh rectal bleeding who were clinically normal. We investigated age at symptom onset, feeding at onset of bleeding, the time of bleeding disappearance, stool smear and culture, endoscopic findings, and histopathologies in the biopsy specimens of 16 not-sick neonates. We performed food ECT in cases with over 4 days of persistent rectal bleeding in the absence of any other etiology. In 16 not-sick neonates with rectal bleeding, the median age at symptom onset was 8.5 (1-43) days. Endoscopic abnormalities were observed in all 16 patients, and in 10 cases satisfying the pathological guidelines for FPIPC, two (12.5 %) were confirmed as FPIPC by food ECT. In the other 14 (87.5 %) cases, rectal bleeding spontaneously disappeared after on average at 4 (1-8) days and thus was diagnosed as idiopathic neonatal transient colitis (INTC).

Conclusions: FPIPC is rare as a cause of small and fresh rectal bleeding in not-sick newborns and most of cases proved to be INTC. Although clinical findings are suspected as its symptoms and histological results satisfy its diagnostic criteria, FPIPC should be carefully confirmed through food ECT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-012-1825-2DOI Listing
December 2012

What is the 'objective' differential factor of diarrhea in infancy?: Normal state versus diarrheal illness in infants with chronic frequent and loose stool.

Korean J Pediatr 2010 Dec 31;53(12):1006-11. Epub 2010 Dec 31.

Department of Pediatrics, Keimyung University, School of Medicine, Daegu, Korea.

Purpose: This study aimed to identify 'objective' differential factors for normal frequent loose stool (NFLS) and diarrheal illness with dehydration and nutritional deficiency (DIDN) among infants with chronic frequent loose stool (CFLS).

Methods: Data were analyzed from infants under 2 years of age with CFLS who had been transferred from general pediatricians. These 46 patients were divided into 2 groups (NFLS versus DIDN). Nocturnal stool was defined as evacuation between 10 pm and 6 am. Maximal stool amount/day (measured using the mother's hand) was specified as the highest score during the period of CFLS obtained by adding up each evacuation's score (range, 0-2 points).

Results: There were 36 cases of NFLS and 10 of DIDN. A failure to gain weight (P=0.0001), fever (P=0.0079), colic/abdominal pain (P=0.0014), gross blood in stool (except allergic proctocolitis) (P=0.0113), nocturnal stool (P=0.0001), and the score of stool amount (P=0.0001) were found to significantly differentiate the groups. A failure to gain weight was observed in 39% of even NFLS. The frequency, mucus content, and microbiological findings of stools, as well as diaper dermatitis were not found to significantly differentiate the groups.

Conclusion: NFLS was more common than DIDN in infants with CFLS. The most 'objective' differential factors were nocturnal stool and the score of stool amount (≥7 points/day).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3345/kjp.2010.53.12.1006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021726PMC
December 2010

Balloon-occluded retrograde transvenous obliteration treats hepatic dysfunction and gastric varices.

J Pediatr Gastroenterol Nutr 2011 Feb;52(2):219-21

Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MPG.0b013e3181f8a8b3DOI Listing
February 2011

Protein losing enteropathy in severe atopic dermatitis in an exclusively breast-fed infant.

Pediatr Dermatol 2009 Sep-Oct;26(5):638-9

Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

We first report a case of protein losing enteropathy in severe atopic dermatitis in an exclusively breast-fed 5-month-old infant. Protein losing enteropathy was confirmed by fecal alpha1-antitrypsin clearance test and imaged successfully by 99mTc-human serum albumin scintigraphy. The present case highlights that protein losing enteropathy in severe infantile atopic dermatitis is being a topic of concern and also an issue even in exclusive breast feeding patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1525-1470.2009.01008.xDOI Listing
January 2010

Probiotic gastrointestinal allergic reaction caused by Saccharomyces boulardii.

Ann Allergy Asthma Immunol 2009 Jul;103(1):87-8

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1081-1206(10)60154-8DOI Listing
July 2009

Diffuse microscopic angiodysplasia and nodular lymphoid hyperplasia in an infant with obscure massive lower gastrointestinal bleeding: a diagnostic challenge.

J Pediatr Surg 2009 Apr;44(4):852-5

Department of Pediatric Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu 700-712, Republic of Korea.

The authors report a rare case of diffuse microscopic angiodysplasia and nodular lymphoid hyperplasia involving the distal ileum and total colon in a 13-month-old girl who had recurrent episodes of massive lower gastrointestinal bleeding of obscure origin. Colonoscopy showed multiple nodular hyperplasia and mucosal erosions, and all other diagnostic studies were negative. At laparotomy, intraoperative transluminal endoscopic transillumination was of benefit in identifying the bleeding foci but could not detect every angiodysplastic lesion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpedsurg.2008.12.007DOI Listing
April 2009

The significance of gastric juice analysis for a positive challenge by a standard oral challenge test in typical cow's milk protein-induced enterocolitis.

J Korean Med Sci 2008 Apr;23(2):251-5

Department of Pediatrics, Institute for Medical Science, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

This study was performed to investigate the significance of gastric juice analysis (GJA) as a diagnostic criterion of a positive challenge in a standard oral cow's milk challenge (OCC) to confirm typical cow's milk protein-induced enterocolitis (CMPIE). Data from 16 CMPIE patients (aged 14 to 44 days) were analyzed. A standard OCC was openly executed using 0.15 g/kg of protein. Three symptoms (vomiting, lethargy, and bloody or pus-like stool), and four laboratory findings (GJA [3 hr], changes in peripheral blood absolute neutrophil count [ANC] [6 hr], C-reactive protein [6 hr], and stool smear test for occult blood or leukocytes) were observed after OCC. Before OCC, baseline studies were conducted; a stool smear test, blood sampling, and GJA. Positive OCC results were; vomiting (87.5%) (observed 1-3 hr after OCC), lethargy (62.5%) (1-3 hr), bloody or pus-like stool (43.8%) (6-10 hr), abnormal GJA (93.8%), an ANC rise >3,500 cells/microL (93.8%), and an abnormal stool smear test (75.0%). A single GJA test after a standard OCC is a sensitive diagnostic criterion of a positive challenge, and may provide an early confirmatory diagnosis of CMPIE. An investigation of positive OCC outcomes helps to find out a diagnostic algorithm of criteria of a positive challenge in CMPIE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3346/jkms.2008.23.2.251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526446PMC
April 2008

Intussusception associated with pseudomembranous colitis.

J Pediatr Gastroenterol Nutr 2008 Apr;46(4):470-1

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MPG.0b013e31816232b7DOI Listing
April 2008

Indexes of suspicion of typical cow's milk protein-induced enterocolitis.

J Korean Med Sci 2007 Dec;22(6):993-7

Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

This study was performed to identify clinical factors that facilitate the diagnosis of typical cow's milk protein-induced enterocolitis (CMPIE). Data from 142 consecutive patients (aged 15 to 45 days, cow's milk formula- or cow's milk and breast milk mixed-fed) admitted due to vomiting and/or diarrhea were retrospectively analyzed. These 142 subjects were divided into three groups: the CMPIE, infection, and non-infection group. Each group was composed of 16 (11.3%), 102 (71.8%), and 24 (16.9%) patients, respectively. On admission, poor weight gain (p=0.003), hypoalbuminemia (p=0.035), peripheral leukocytosis (p=0.012), and metabolic acidosis (p=0.015) were found to be more significant in the CMPIE group than those in other two groups. In CMPIE, serum albumin levels decreased from 3.3+/-0.9 g/dL on admission to 2.6+/-0.3 g/dL during admission (p<0.05), and methemoglobinemia was observed in 3 patients (18.8%) (p=0.012). Multiple logistic regression analysis showed that the independent predictors of CMPIE versus the infection group were failure to gain weight (OR, 10.75 [95% CI, 1.53-66.12]) (p= 0.014) and hypoalbuminemia (OR, 9.53 [95% CI, 1.62-49.01]) (p=0.010). The early recognition of indexes of suspicion for CMPIE may be of help in the diagnosis and treatment of this disorder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694639PMC
http://dx.doi.org/10.3346/jkms.2007.22.6.993DOI Listing
December 2007

12-O-tetradecanoyl phorbol 13-acetate induces the expression of B7-DC, -H1, -H2, and -H3 in K562 cells.

Int J Oncol 2007 Dec;31(6):1439-47

Chronic Disease Research Center and Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea.

Induction of the B7 family molecules by 12-O-tetradecanoyl phorbol 13-acetate (TPA) has been reported, however, the mechanism by which TPA up-regulates these molecules remains poorly understood. In this study, the expression of B7-DC, -H1, -H2, and -H3 in response to TPA was markedly induced in K562 cells. TPA also induced activation of ERK, p38 mitogen-activated protein kinase (MAPK), JNK, phosphatidylinositol-3-kinase (PI-3K), or nuclear factor (NF)-kappaB. Pre-treatments with protein kinase C (PKC) inhibitors significantly inhibited TPA-induced expression of B7-DC, -H1, -H2, and -H3 mRNA as well as TPA-induced phosphorylation of ERK, p38 MAPK, JNK, and PI-3K. TPA-induced expression of B7-DC, -H1, -H2, and -H3 mRNA was abrogated by pre-treatments with inhibitors of ERK and p38 MAPK. However, inhibition of PI-3K and JNK only caused decrease of TPA-induced B7-DC mRNA and B7-H3 mRNA, respectively. TPA-induced degradation of IkappaB-alpha was markedly abrogated by treatments with PKC inhibitors, but not by treatments with inhibitors of ERK, p38 MAPK, JNK, or PI-3K. NF-kappaB inhibitors significantly attenuated the expression of B7-DC, -H1, -H2, and -H3 mRNA in response to TPA. These results suggest that TPA induces the expression of B7-DC, -H1, -H2, and -H3 mRNA in K562 cells via activation of PKC, ERK, p38 MAPK, and NF-kappaB. Distinctly, the expression of B7-DC mRNA and -H3 mRNA in response to TPA is also PI-3K- and JNK-dependent, respectively.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2007

Advanced criteria for clinicopathological diagnosis of food protein-induced proctocolitis.

J Korean Med Sci 2007 Apr;22(2):213-7

Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu, Korea.

The clinicopathological findings in previous studies concerning food protein-induced proctocolitis (FPIPC) are quite diverse in terms of results and conclusions. The aim of this study was to suggest advanced clinicopathological diagnostic criteria that facilitate the early confirmation of FPIPC. Data of 38 FPIPC patients, who had received sigmoidoscopy and biopsy, was analyzed. Microscopic findings were compared with observations of previous studies. Feeding at onset of bleeding was exclusively breast-fed (94.7%) and formula-fed or mixed-fed (5.3%). Endoscopic abnormalities were observed in all patients; nodular hyperplasias with circumscribed and/or central pit-like erosions in 94.7% and erythema in 5.3%. Histopathological findings were; lymphoid aggregates in 94.7%, eosinophils in lamina propria of >or=60 cells/10 HPF in 97.4% and of >20 cells/HPF in 63.2%, epithelial or muscularis mucosa eosinophil infiltration in 97.4%, and crypt abscess in 2.6%. The majority of FPIPC patients are exclusively breast-fed and nodular hyperplasias with erosions may be a disease specific endoscopic finding. Histologic diagnosis of FPIPC is compatible with eosinophils in the lamina propria of >or=60 cells/10 high power fields; however, >20 cells/HPF is not an appropriate diagnostic criterion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693584PMC
http://dx.doi.org/10.3346/jkms.2007.22.2.213DOI Listing
April 2007

Clonazepam treatment of pathologic childhood aerophagia with psychological stresses.

J Korean Med Sci 2007 Apr;22(2):205-8

Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu, Korea.

The treatment of pathologic aerophagia has rarely been discussed in the literature. In this retrospective study, the authors investigated the effects of clonazepam on the management of pathologic childhood aerophagia (PCA) with psychological stresses (PS), but not with mental retardation. Data from 22 consecutive PCA patients with PS (aged 2 to 10 yr), who had been followed up for over 1 yr, were reviewed. On the basis of videolaryngoscopic views, the authors observed that the pathology of aerophagia was the result of reflex-induced swallowing with paroxysmal openings of the upper esophageal sphincter due to unknown factors and also observed that these reflex-induced openings were subsided after intravenous low dose benzodiazepine administration. Hence, clonazepam was administered to treat paroxysmal openings in these PCA patients with PS. Remission positivity was defined as symptom-free for a consecutive 1 month within 6 months of treatment. The results of treatment in 22 PCA patients with PS were analyzed. A remission positive state was documented in 14.3% of PCA patients managed by reassurance, and in 66.7% of PCA patients treated with clonazepam (p=0.032). Thus, clonazepam may produce positive results in PCA with PS. Future studies by randomized and placebo-controlled trials are needed to confirm the favorable effect of clonazepam in PCA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693582PMC
http://dx.doi.org/10.3346/jkms.2007.22.2.205DOI Listing
April 2007

How strong construction toy magnets are! A gastro-gastro-duodenal fistula formation.

J Pediatr Gastroenterol Nutr 2007 Feb;44(2):291-2

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MPG.0b013e31802c6e69DOI Listing
February 2007

A case of primary gastric lymphoma in a child.

J Pediatr Hematol Oncol 2006 May;28(5):296-9

Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

Primary gastric lymphoma is a rare gastrointestinal cancer in children. Adult cases of primary gastric lymphoma are often associated with Helicobacter pylori infection and in the past were treated mainly by surgery with additional chemotherapy and/or radiotherapy. We experienced a case recently of a primary gastric lymphoma in a girl. She presented at our hospital with epigastric abdominal pain and upper gastrointestinal bleeding. Chemotherapy alone sufficiently controlled the disease and no additional therapeutic modalities were needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.mph.0000212911.37512.6aDOI Listing
May 2006

Clinical quiz. Cytomegalovirus infection.

J Pediatr Gastroenterol Nutr 2006 May;42(5):607-8

Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.mpg.0000164206.13669.3cDOI Listing
May 2006

Clinical features of pathologic childhood aerophagia: early recognition and essential diagnostic criteria.

J Pediatr Gastroenterol Nutr 2005 Nov;41(5):612-6

Division of Pediatric Gastroenterology & Nutrition, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

Objective: This study investigated the early recognition and diagnosis of pathologic childhood aerophagia to avoid unnecessary diagnostic approaches and serious complications.

Methods: Between 1995 and 2003, data from 42 consecutive patients with pathologic childhood aerophagia, aged 2 to 16 years, were reviewed. An esophageal air sign was defined as an abnormal air shadow on the proximal esophagus adjacent to the trachea on a full-inflated chest radiograph.

Results: Of the 42 patients, the chief complaints were abdominal distention (52.4%), recurrent abdominal pain syndrome (21.4%), chronic diarrhea (11.9%), acute abdominal pain (7.1%) and others (7.2%). Mean symptom duration before diagnosis was 10.6 months (range, 1 to 60 months), and it exceeded 12 months for 16 (38.1%) patients. The clinical features common to all patients were abdominal distention that increased progressively during the day, increased flatus on sleep, increased bowel sound on auscultation and an air-distended stomach with increased gas in the small and large bowel by radiography. Visible or audible air swallowing (26.2%) and repetitive belching (9.5%) were also noted. Esophageal air sign was observed in 76.2% of the patients and in 9.7% of the controls (P=0.0001). The subgroups of pathologic childhood aerophagia divided by underlying associations were pathologic childhood aerophagia without severe mental retardation (76.2%), which consisted of psychological stresses and uncertain condition, and pathologic childhood aerophagia with severe mental retardation (23.8%).

Conclusions: The common manifestations of pathologic childhood aerophagia may be its essential diagnostic criteria, and esophageal air sign may be useful for the early recognition of pathologic childhood aerophagia. Our observations show that the diagnostic clinical profiles suggested by Rome II criteria should be detailed and made clearer if they are to serve as diagnostic criteria for pathologic childhood aerophagia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.mpg.0000179856.68968.e0DOI Listing
November 2005

Shock-associated nonocclusive ischemic colitis in an infant: a very rare complication of incarcerated inguinal hernia.

J Pediatr Gastroenterol Nutr 2005 Oct;41(4):474-6

Department of Pediatrics, Dongsan Medical Center, Keimyung University School of Medicine, Dongsan-dong, Daegu, Korea.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/01.mpg.0000177705.37904.12DOI Listing
October 2005

[Abnormal electron microscopic findings of nonalcoholic steatohepatitis and related factors].

Korean J Gastroenterol 2005 Jun;45(6):417-24

Department of Internal Medicine, Keimyung University College of Medicine, Daegu, Korea.

Background/aims: In spite of increasing interests about nonalcoholic steatohepatitis (NASH), there are few reports about the ultrastructure of hepatocyte in this disease. The aim of this study was to clarify abnormal electron microscopic (EM) findings and related factors in NASH.

Methods: Total of fourteen patients who underwent liver biopsy due to steatohepatitis were included. Precise personal history was taken and variable blood tests such as liver function test, lipid profile, and serum iron study were done. Pathologic examination with light and electron microscopy was done by single pathologist.

Results: Eleven men and three women were included and mean age was 33.7+/-12.8 years. Nine patients drinking less than 40 g/week was grouped as "NASH group" and other 5 patients drinking more than 40 g/week and body mass index less than 25 was grouped as "ASH (Alcoholic Steatohepatitis) group". Polymorphism of mitochondria such as megamitochondria or loss of cristae was major abnormal EM findings and was more common in "NASH group" than "ASH group" (p=0.027). There was no significant clinical or pathological factors related with the presence of these abnormal EM findings.

Conclusions: Polymorphism of mitochondria is major abnormal EM finding of steatohepatitis and is more common in NASH than ASH. And there is no significant clinical or pathological factors which could predict the presence of these abnormal EM findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2005

Resolution of refractory chylous ascites after Kasai portoenterostomy using octreotide.

J Pediatr Surg 2004 Dec;39(12):1806-7

Department of Pediatric Sugery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea , South Korea.

Chylous ascites is a rare disorder with variables causes. Herein, the authors report a case of refractory chylous ascites after Kasai operation for biliary atresia, which was treated successfully with subcutaneous octreotide, a synthetic somatostatin analogue. To the best of the authors' knowledge, this is the first report in the English-language literature of post-Kasai chylous ascites being successfully treated with subcutaneous octreotide in parallel with the continuation of enteral feeding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpedsurg.2004.08.009DOI Listing
December 2004

Expression of transforming growth factor beta1, transforming growth factor type I and II receptors, and TNF-alpha in the mucosa of the small intestine in infants with food protein-induced enterocolitis syndrome.

J Allergy Clin Immunol 2002 Jan;109(1):150-4

Department of Pediatrics, Pathology, and Clinical Pathology, School of Medicine, Catholic University of Taegu, Korea.

Background: TNF-alpha secreted by activated T cells is known to increase intestinal permeability, whereas transforming growth factor (TGF) beta has the ability to protect the epithelial barrier.

Objective: We determined the expression of TGF-beta1, its receptors, and TNF-alpha on the mucosa of small intestine to investigate their roles in the pathogenesis of food protein-induced enterocolitis syndrome (FPIES).

Methods: Twenty-eight infants diagnosed with FPIES by means of clinical criteria and challenge test results were included. Immunohistochemical stains for TGF-beta1, type 1 and 2 TGF-beta receptors, and TNF-alpha on duodenal biopsy specimens were performed.

Results: TGF-beta1 expression was generally depressed in patients. Expression of type 1 TGF-beta receptor was significantly lower in the patients who had villous atrophy compared with expression in those patients who did not (P <.001) and negatively correlated with the severity of atrophy (r = -0.59, P <.001). Expression of type 2 TGF-beta receptor showed no significant difference between the patients with or without villous atrophy. The immunoreactivity for both TGF-beta receptors on lamina proprial cells was slight or negative. TNF-alpha expression was detected on both epithelial and lamina proprial cells and was significantly greater in the patients who had villous atrophy compared with that in the patients who did not (P <.01).

Conclusion: Our results suggest that decreased countering activity of TGF-beta1 against T-cell cytokines is implicated in the pathogenesis of FPIES. The significantly lower expression of type 1 TGF-beta receptor compared with type 2 receptor suggests the differential contribution of each receptor to the diverse biologic activities of TGF-beta in the intestinal epithelium.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1067/mai.2002.120562DOI Listing
January 2002