• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.12 no.1
• /
• pp.30-38
• /
• 2009

Purpose: To investigate the physical and biochemical parameters related with elevated serum alanine aminotransferase (ALT) levels in obese children. Methods: One hundred forty-two obese or overweight children who visited the out-patient clinics of Chungnam National University Hospital between January 2006 and August 2008 were enrolled. Physical measures and biochemical tests were performed in all patients. Liver sonography was performed in 43 patients. They were divided into the following 2 groups based on ALT levels: group I, normal ALT levels (n=65); and group II, elevated ALT levels (n=77). We compared the physical measures, biochemical results, and ultrasonographic findings of the livers in both groups. Other causes of elevated serum ALT levels were ruled out. Results: The male-to-female ratios were 1.6:1 in group I and 7.6:1 in group II. Among physical parameters, the waist circumference-to-height ratio and hip circumference-to-height ratio were significantly higher in group II (p=0.001 and 0.046, respectively). Among biochemical parameters, aspartate aminotransferase (AST), ${\gamma}$-glutamyltransferase (${\gamma}$-GT), and total cholesterol levels were significantly higher in group II (p<0.001, 0.001, and 0.001, respectively). The AST/ALT ratio was <1 (mean, 0.55) and statistically lower in group II. There was a positive correlation between the serum ALT level and ${\gamma}$-GT (p<0.001, r=0.750), and a positive correlation between the serum ALT level and the waist circumference-to-height ratio in group II (p<0.001, r=0.401). Conclusion: The results suggest that the waist circumference-to-height ratio and ${\gamma}$-GT may be associated with elevated alanine aminotransferase activity in obese children.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.1 no.1
• /
• pp.100-106
• /
• 1998

Purpose: Ceftriaxone, a potent parenteral third-generation semisynthetic cephalosporin is widely used for the treatment of a variety of bacterial infections in both children and adult. Review of recent data indicates that ceftriaxone treatment has been associated with the development of reversible biliary pseudolithiasis and that is thought by many to be a benign process. Despite, several reports describe patients with ceftriaxone pseudolithiasis who required cholecystectomy for presumed acute cholecystitis. In this study we evaluated the incidence, risk factors, and prognosis of gallbladder pseudolithiasis after ceftriaxone treatment. Methods: Between march, 1997 and January, 1998, any child admitted to the Children's hospital of National University of Seoul and prescribed ceftriaxone for probable or definite bacterial infection were eligible for the study. 21 of them had ultrasound examination on the 2~12 days later after the start of ceftriaxone treatment, 8 of whom documented gallbladder precipitates or pseudolithiasis during treatment by serial abdominal ultrasound. Repeat abdominal ultrasound was performed 10~80 days later after the end of ceftriaxone treatment. The children with underlying liver disease or decreased renal function were excluded in this study. Results: 1) 21 children had ultrasound examinations of gallbladder during ceftriaxone treatment and 8 (38%) of them acquired pseudolithiasis. 2) The patients who developed gallbladder pseudolithiasis were significantly older ($6.3{\pm}2.9$ yr. vs $2.2{\pm}3.1$ yr.)(p<0.05), and older than 24 months were probably the significant risk associated with this phenomenon (p<0.05). However, no significant differences in sex, type of infection, fasting, and ceftriaxone treatment regimen (dose, duration of therapy). 3) The abnormality found on gallbladder ultrasonography was a strikingly hyperechogenic material with post-acoustic shadowing in 5 patients without post-acoustic shadowing in 3 patients 4) Follow up of gallbladder ultrasound was performed in 6 patients after cessation of ceftriaxone treatment. Sonographic abnormalities completely resolved within 14 days post cessation of therapy in 2 patients; 30 days, 1 patient; 80 days, 3 patients. Conclusions: We suggest that routine abdominal ultrasound should be considered in all children who received high dose ceftriaxone in more than 24 months of age and developed hepatobiliary symptoms during or just after ceftriaxone treatment.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.13 no.2
• /
• pp.164-171
• /
• 2010

Purpose: Iron deficiency anemia (IDA) is one of the most common nutritional problems, despite a recent improvement of nutritional status of infants and children. We assessed the risk factors for IDA in infants and vitamin D deficiency and IDA by nutrition analysis. Methods: We analyzed blood tests and evaluated 103 children with IDA and 123 children without IDA, 6-36 months of age, who were cared for in our hospital between March 2006 and July 2010. Nutritional analysis using Canpro was performed among breastfed infants 6~12 months of age who had been diagnosed with IDA and had detailed diet histories. Results: Breastfed infants accounted for 87.4% and 40.7% of the IDA and comparison groups, respectively. The IDA and comparison groups began weaning food at 6.4${\pm}$1.8 and 5.9${\pm}$1.3 months, respectively. In the IDA and comparison groups, 46.4% and 53.5% began to adapt to weaning food within 4 weeks, respectively. The most common reason for hospital care of the IDA group was respiratory symptoms constituting 36.2%. Only 18.6% visited the hospital for palloror anemia. The Canpro analysis, performed on 11 infants with IDA, showed that iron and vitamin D were <40% and 30% of recommended intakes, respectively. Conclusion: Weaning food should be started 4~6 months of age in breastfed infants. In infants at high risk for IDA and vitamin D deficiency, screening tests should be recommended. The high-risk infants may require iron, vitamin D fortified formula, or oral supplements.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.13 no.2
• /
• pp.154-163
• /
• 2010

Purpose: Colonic polyposis is less common in children than in adults. The clinical data pertaining to colonic polyposis in children are limited. Children with colonic polyposis have complications associated with numerous polyps, malignant transformation of the polyps, and extraintestinal neoplasms. We studied the clinical spectrum, endoscopic characteristics, and histologic findings of colonic polyposis in Korean children. Methods: We reviewed the clinical data of 37 children with multiple colonic polyps between 1987 and 2009. The mean age at the time of diagnosis of colonic polyposis was 8.0${\pm}$3.2 years. Results: Peutz-Jeghers syndrome, juvenile polyposis syndrome, familial adenomatous polyposis (FAP), and lymphoid polyposis was diagnosed in 22, 7, 6, and 2 children, respectively. The most common clinical presentation in children with colonic polyposis was hematochezia. A family history of colonic polyposis was noted in 7 children. The colonoscopic findings of colonic polyposis varied with the size and number of polyps. The majority of polyps were multi-lobulatd and pedunculated in children with Peutz-Jeghers syndrome. The polyps in children with juvenile polyposis syndrome were primarily round and pedunculated. For the children with FAP, the colon was carpeted with small, sessile polyps. There were multiple sessile polyps in the patients with lymphoid polyposis. Surgical polypectomy was performed in 14 children (38%). Intestinal segmental resection was performed in 13 children (35%). Four patients with FAP underwent total colectomy. Four children with Peutz-Jeghers syndrome had extraintestinal neoplasms. No malignant transformation of polyp was identified. Conclusion: Children with colonic polyposis should undergo a careful initial evaluation and require periodic re-evaluation.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.7 no.1
• /
• pp.1-7
• /
• 2004

Purpose: Alvarado scoring system was evaluated regarding its usefulness for the early diagnosis of acute appendicitis in adult and in reduction of the incidence of negative appendicectomies. To evaluate the accuracy of diagnosing appendicitis using the Alvarado score in children. Methods: Prospectively, we surveyed 122 patients (male 67, female 55) suffering from abdominal pain, who had visited to the emergency department of Chosun University Hospital from June 2002 to May 2003. The Alvarado score has been computed from the white blood cell count, neutrophil count, body temperature, resistance in the right lower quadrant, length of symptoms, nausea and vomiting. Each patient was evaluated by a pediatric resident and then by a general surgeon independently. Results: Out of 170 total children who visited to the emergency department due to abdominal pain, 122 patients were associated with appendicitis. A total of 122 patients (67 male and 55 female) were visited to the emergency room with suspected appendicitis. From 105 operated patients, 92 (87.6%) were diagnosed acute appendicitis and erronous diagnostic rate was 12.4%, pathologically. Mean alvarado score of appendicitis group was $5.40{\pm}1.24$ whereas those of non-appendicitis group was $3.73{\pm}1.82$ (p<0.05). From 6 Alvarado score high sensitivity (86.4%) and high specificity (80.0%) were observed. Sensitivity of ultrasonography or computed tomography was 92.5%. Conclusion: We found that Alvarado score system is a noninvasive, safe diagnostic method, which is simple, reliable and repeatable. Alvarado score is useful system for a first, rapid and economic evaluation for the appendicitis in children.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.3 no.1
• /
• pp.68-74
• /
• 2000

Purpose: This study was to investigate the clinical manifestations of FTT in children. Methods: From March 1997 to July 1999, clinical observations were made on patients with FTT who had visited to Samsung Medical Center. Detailed histories and through physical examinations were taken, and when suspected organic FTT, basic laboratory studies were done. Results: Upon the review of medical records, we investigated the clinical manifestations of 74 children, aged 1 month and 13 year 1 month. The causes of FTT were composed of either physiologic (47.8%) or pathologic (52.2%) ones. Among the physiologic FTT, were there familial short stature (FSS, 14.5%), intrauterine growth retardation (IUGR, 14.5%), constitutional growth delay (CGD, 11.6%), idiosyncrasy and prematurity. Among pathologic causes, neurologic disorders (20%) are the most common causes of FTT, and then follow by GI (13.4%), allergic and infectious disorders in decreasing order. The data showed that average caloric intake in patients with FTT was 76,2% of recommended amount. FTT patients with CGD, IUGR, and idiosyncrasy had tendency to take small foods. The FTT children with prematurity, IUGR and pathologic FTT, were short and thin for their ages. However FTT children with CGD and FSS had tendency to be thin with relatively normal heights for their ages, in comparison with those of the children with prematurity, IUGR and pathologic FTT. Conclusion: The diagnosis of FTT was easily obtained with simple and through medical history, physical examination, and minimal laboratory tests. In this study, organic FTT was more prevalent than physiologic one. This results indicate that early intervention is mandatory, because children may develop significant long-term sequelae from nutritional deficiency.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.6 no.2
• /
• pp.103-111
• /
• 2003

Purpose: This study was undertaken to evaluate the gastroduodenal pathology and Helicobacter pylori infection in children with upper gastrointestinal symptoms. Methods: One hundred and seven pediatric patients with upper gastrointestinal symptoms were undergone endoscopy at the Gyeongsang National University Hospital from June 1990 to April 1991. Histopathologic examination was done by H & E staining of gastric antral biopsy specimen and gastritis was defined according to the Sydney System. Tissue H. pylori status was evaluated with the urease test using Christensen's urea broth and H & E or Warthin-Starry silver staining of gastric antral biopsy specimen. IgG Immunoblotting were also performed to detect specific anti-H. pylori antibody in these patients. Results: The reasons for endoscopy were recurrent abdominal pain, acute abdominal pain, sallow face, hunger pain, and frequent nausea. Variable degrees of gastric mucosal hyperemia were found in most of the patients. Gastric hemorrhagic spots, gastric ulcer, duodenal ulcer, duodenal erosion, and hemorrhagic duodenitis were rare endoscopic findings. Histologic chronic gastritis was found in 88% of 107 patients. Histologic chronic duodenitis was observed in all 99 patients whose tissue were available. Gastric tissue H. pylori was positive in 57% of 107 patients by one of the ureasetest, H & E staining and Warthin-Starry silver staining. However, gastric tissue H. pylori detection rate was lower in the younger age groups. Anti-H. pylori IgG antibodies were detectable in 96% of 107 patients. Conclusion: Chronic gastroduodenitis and anti-H. pylori IgG antibody were ubiquitous in children with upper gastrointestinal symptoms.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.14 no.1
• /
• pp.67-73
• /
• 2011

Purpose: Recently, the incidence of acute hepatitis A has increased nationwide and is related to a low rate of IgG anti-HAV production. To establish effective measures for preventing hepatitis A virus infection, an epidemiologic study on the seroprevalence of anti-HAV is needed. Thus, we investigated the seroprevalence of IgG anti-HAV in children living in Gwangju and Jeonnam. Methods: IgG anti-HAV levels were measured in a total of 1,435 patients who visited Chosun University Hospital between January 2009 and December 2009. Results: The overall seropositve rate was 40.8% (586/1,435). The seropositive rates were 41% among children under the age of 1 year, 49.9% for children 1~5 years old, 51.1% among individuals 5~10 years old, 12.9% for individuals 10~15 years old, and 8.2% for subjects over 15 years old. There was no significant difference between genders in any group. The seropositive rates in Gwangju and Jeonnam were 57.3% and 32.9% for children under the age of 1 year, 52.5% and 44.3% for children 1~5 years old, 60.2% and 33.9% among children 5~10 years old, 14.1% and 9.7% for children 10~15 years old, and 10.8% and 4.2% for individuals over 15 years old. Conclusion: The results demonstrated the low rates of IgG anti-HAV, particularly among subjects over 10 years old, which suggests the possibility of increasing clinical HAV infection rates among adults in the near future. We should actively prevent the spread of hepatitis A virus. Vaccination is the most effective means of preventing hepatitis A virus transmission among persons at risk for infection. Hepatitis A vaccination is recommended for children who have low IgG anti-HAV seropositive rates.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.11 no.2
• /
• pp.116-121
• /
• 2008

Purpose: Cricopharyngeal incoordination is a rare cause of swallowing difficulties in newborns and infants; it is characterized by delayed pharyngeal contractions related to cricopharyngeal relaxation. Dysphagia and repeated aspiration are common findings despite normal sucking. We conducted this study to assess the clinical features of cricopharyngeal incoordination in newborns and infants. Methods: An analysis of the clinical data from 17 patients with cricopharyngeal incoordination who were admitted to the Department of Pediatrics, Pusan National University Hospital, between 2000 and 2006 was conducted retrospectively. The diagnosis of cricopharyngeal incoordination was established by the clinical characteristics and the videofluoroscopic swallowing studies. Results: The male to female ratio was 1:1.1 (males 8, females 9) the age range 1 to 60 days. The body weight of 11 patients (64.7%) was less than the $10^{th}$ percentile at diagnosis. Six patients (35.3%) were born prematurely. The associated anomalies or diseases were chromosomal anomaly (2 cases), congenital heart disease (3 cases), and laryngomalacia, hypoxic brain damage or neonatal seizures (1 case each). The chief complaints of patients were recurrent aspiration pneumonia (10 cases), feeding difficulty (9 cases), dyspnea (4 cases), and chocking (4 cases). The severity of aspiration on the videoesophagogram or esophagogram was mild in 12 cases. The correlation between the severity of aspiration and the duration of tube feeding after the diagnosis was significant (p<0.05). Conclusion: Cricopharyngeal incoordination should be considered in the differential diagnosis of newborns and infants, without known risk factors associated with swallowing dysfunction, when they present with unexplained respiratory problems. Although the prognosis of cricopharyngeal incoordination is good, early diagnosis and tube feeding are recommended to prevent the complications associated with this disorder.

• Journal of Gastric Cancer
• /
• v.7 no.2
• /
• pp.82-87
• /
• 2007

Purpose: In gastric cancer patients with gastric outlet obstruction, there are several complications such as malnutrition and vomiting. Palliative enteral stenting is a less invasive procedure as compared with a gastrojejunostomy. The aim of this study was to determine whether there was a significant difference between patients that undergone palliative enteral slanting and patients that had received a bypass gastrojejunostomy. Materials and Methods: One hundred patients underwent palliative entering stenting and 3f patients were subjected to a surgical bypass gastrojejunostomy. We reviewed the medical records of the patients with gastric outlet obstruction secondary to far advanced gastric cancer that were diagnosed using a gastrofibroscope, UGI and abdominal CT, and were admitted to our institution between January 2000 and August 2006. The outcome of stent placement for gastric outlet obstruction was compared with palliative gastrojejunostomy during the same period. We excluded patients with recurrent gastric cancer and double cancer from this study. Results: There were significant differences between the group of patients that underwent slanting and the group of patients that received a gastrojejunostomy regarding the age of patients ($67{\pm}12$ vs. $57{\pm}9$, P<0.001) but not between the sex of the patients (M : F, 2 : 1 vs. 2 :1, P=0.637). The most common complication of stenting was tumor ingrowth (16/100, 16%) and the second most common complication was stent migration (14/100). Failure of the procedure occurred in only three patients. Twenty-three patients underwent re-slanting and one patient required open conversion with a gastrojejunostomy. The median time to the first meal was $4{\pm}2$ days in the stent group of patients and $6{\pm}2$ days in the gastrojejunostomy group of patients (P=0.001). The median postoperative hospital stays were 9 days in the stent group of patients and 15 days in the gastrojejunostomy group of patients (P=0.003). The mean survival periods were 11 months in the stent group of patients and 10 months in the gastrojejunostomy group of patients (P=0.937). Conclusion: There were no significant differences In the mean survival rates. An earlier first meal and a shorter hospitalization stay were found in the slanting group of patients compared to the bypass gastrojejunostomy group of patients. However, re-slanting was a concern due to tumor ingrowth and stent migration.