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Chen CC, Huang JL, Chen KJ, Kong MS, Hua MC, Yeh YM, Chang HJ. Comparison of 16S rRNA gene sequencing microbiota among children with serological IgE-mediated food hypersensitivity. Pediatr Res 2024; 95:241-250. [PMID: 37648747 DOI: 10.1038/s41390-023-02735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND We hypothesized that specific food hypersensitivity (FH) in children is linked to specific gut microbiota. The aim of our study was to quantify and evaluate differences in gut microbial composition among children with different IgE-mediated FH. METHODS Children (n = 81) aged 18 to 36 months were enrolled, fecal samples of 57 children with FH and 24 healthy children were evaluated using next-generation sequencing. Individual microbial diversity and composition were analyzed via targeting the 16 S rRNA gene hypervariable V3-V5 regions. RESULTS Children with IgE-mediated FH (in milk, egg white, soy) had significantly lower gut microbiota diversity and richness than healthy children. Children with IgE-mediated FH exhibited relatively high abundances of Firmicutes and relative underrepresentation of the phylum Bacteroidetes. We observed significant increases in relative abundances of Ruminococcaceae, Clostridiaceae, and Erysipelotrichaceae (p < 0.01, compared to control) in children with milk hypersensitivity and of Clostridiaceae and Erysipelotrichaceae (p < 0.01) in children with peanut hypersensitivity. We also found significant increases in the numbers of Clostridiaceae, Lachnospiraceae and Pasteurellaceae (p < 0.01) in children with egg white hypersensitivity. CONCLUSIONS These findings identify early evidence of different gut microbiota development/ differentiation in children with food hypersensitivity. Specific food hypersensitivities may be associated with compositional changes in intestinal microbiota. IMPACT These findings identify early evidence of different gut microbiota development/differentiation in children with food hypersensitivity. We built a gut microbial profile that could identify toddlers at risk for food hypersensitivity. Children with enriched Firmicutes (phylum) with partial different families may be associated with food hypersensitivity. Enriched family Clostridiaceae, Ruminococcaceae, Lachnospiraceae, or Erysipelotrichaceae in gut microbiota may be associated with specific food hypersensitivities (such as milk, egg white, peanut) in children.
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Affiliation(s)
- Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Jing-Long Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, New Taipei Municipal Tu Cheng Hospital, Chang Gung Memorial Hospital, New Taipei, Taiwan
| | - Kun-Jei Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Chin Hua
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yuan-Ming Yeh
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hung-Ju Chang
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Lin HY, Chen CC, Kong MS. Accessory lobe of the liver in a 14-year-old girl. Pediatr Neonatol 2019; 60:337-338. [PMID: 29706361 DOI: 10.1016/j.pedneo.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/03/2018] [Accepted: 04/09/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Hsin-Yeh Lin
- Department Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.
| | - Chien-Chang Chen
- Department Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC.
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Lai HH, Chiu CH, Kong MS, Chang CJ, Chen CC. Probiotic Lactobacillus casei: Effective for Managing Childhood Diarrhea by Altering Gut Microbiota and Attenuating Fecal Inflammatory Markers. Nutrients 2019; 11:nu11051150. [PMID: 31126062 PMCID: PMC6566348 DOI: 10.3390/nu11051150] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Acute diarrhea is a major cause of childhood morbidity and an economic burden for families. The aim of this study is to explore the effect of probiotics on clinical symptoms, intestinal microbiota, and inflammatory markers during childhood diarrhea. Methods: Children (n = 81) aged six months to six years (mean age 2.31 years) hospitalized for acute diarrhea were randomized to receive probiotics (Lactobacillus casei variety rhamnosus; n = 42) or no probiotics (n = 39) orally twice daily for seven days. Feces samples were also collected to evaluate microbial content using a traditional agar plate and next-generation sequencing. Immunoglobulin A (IgA), lactoferrin, and calprotectin were determined by enzyme-linked immunosorbent assay (ELISA) and compared in different groups. Other clinical symptoms or signs, including fever, vomiting, diarrhea, abdominal pain, bloated abdomen, daily intake, appetite, and body weight were also assessed. Results: Data were collected from 81 individuals across three different time points. Total fecal IgA levels in fecal extracts of the probiotics group were higher than those in the control group, reaching statistical significance (p < 0.05). Concentrations of fecal lactoferrin and calprotectin were significantly downregulated in patients with probiotic Lactobacillus casei variety rhamnosus (Lc) consumption compared to those of the control (p < 0.05). Probiotic Lc administration may be beneficial for gut-microbiota modulation, as shown by the data collected at one week after enrollment. Counts of Bifidobacteria and Lactobacillus species were elevated in stool culture of the probiotic group. Appetite and oral intake, body-weight gain, abdominal pain, bloating, as well as bowel habits (diarrhea) were much better in children receiving probiotics compared with those in the control group. Conclusion: Fecal IgA increased during acute diarrhea under Lc treatment; in contrast, fecal lactoferrin and calprotectin were downregulated during acute diarrhea under Lc treatment. Probiotic Lc may be a useful supplement for application in children during acute diarrhea to reduce clinical severity and intestinal inflammatory reaction.
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Affiliation(s)
- Hung-Hsiang Lai
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33303, Taiwan.
| | - Cheng-Hsun Chiu
- Division of Infectious Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33303, Taiwan.
| | - Man-Shan Kong
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33303, Taiwan.
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medical Sciences, Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan 33303, Taiwan.
| | - Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33303, Taiwan.
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Chang CH, Chao HC, Kong MS, Chen SY, Chen CC, Lai MW. Clinical and nutritional outcome of pediatric esophageal stenosis with endoscopic balloon dilatation. Pediatr Neonatol 2019; 60:141-148. [PMID: 29793843 DOI: 10.1016/j.pedneo.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 02/18/2018] [Accepted: 04/30/2018] [Indexed: 11/15/2022] Open
Abstract
AIM The present study evaluates the long-term clinical and nutritional effect to endoscopic balloon dilatation (EBD) in pediatric esophageal stricture. METHODS This was a 15-year retrospective study involving pediatric patients with esophageal stricture treated with EBD. Outcome parameters included the number of dilatations, procedural success rates, nutritional status, and complications. EBD was performed in patients with a dysphagia score greater than 2. The nutritional status was assessed by weight-for-age z-score. Clinical success was defined as no requirement for EBD for at least 1 year and/or increasing interval between dilatation and the numbers of EBD was fewer than 4 times per year. RESULTS A total of 50 cases (mean age, 4.41 ± 4.9 years) were enrolled. During a mean follow-up of 3.2 ± 1.9 years, a total of 268 EBD sessions were performed, with an average of 5.36 sessions per patient (range, 1-33). Patients who had short segment stricture (<2 cm) were prone to achieve clinical success after EBD (p = 0.0094). Procedural perforation rate is 2.6% (7/268); subsequent tracheoesophageal fistula occurred in two patients. The clinical success rate of EBD therapy was 72% (36/50). All had increments of weight-for-age z-score after EBD therapy, and the increment was significantly greater in those patients with short segment stricture or stricture in the middle esophagus at 12 months (p = 0.01 and 0.008, respectively). CONCLUSIONS EBD has good long-term clinical success and nutritional promotion in pediatric patients with esophageal stricture, especially in short segment stricture or stricture in the middle esophagus.
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Affiliation(s)
- Chun-Hsiang Chang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan.
| | - Man-Shan Kong
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
| | - Shih-Yen Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Guishan Dist, Taoyuan City, 33305, Taiwan; Chang Gung University College of Medicine, 259, Wenhua 1st Rd., Taoyuan City, 33302, Taiwan
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Yu WJ, Chen SY, Tsai CN, Chao HC, Kong MS, Chang YJ, Chiu CH. Long-term impact of suboptimal rotavirus vaccines on acute gastroenteritis in hospitalized children in Northern Taiwan. J Formos Med Assoc 2018; 117:720-726. [DOI: 10.1016/j.jfma.2017.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/12/2017] [Accepted: 09/18/2017] [Indexed: 12/26/2022] Open
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Lu YA, Chiu CH, Kong MS, Wang HI, Chao HC, Chen CC. Risk factors for poor outcomes of children with acute acalculous cholecystitis. Pediatr Neonatol 2017; 58:497-503. [PMID: 28499592 DOI: 10.1016/j.pedneo.2016.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/13/2016] [Accepted: 12/30/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute acalculous cholecystitis (AAC) is generally considered to be a mild disease in children; however, if left untreated or treated without caution, AAC can lead to severe outcomes, such as death. The objectives of this study were to present the clinical features and identify the predictors of mortality in pediatric AAC. METHODS Patients diagnosed with AAC between 2005 and 2012 were enrolled. AAC was defined by the presence of fever and an echo-proven thickened gallbladder wall exceeding 4 mm. A poor health outcome was defined as death. Further information related to the demographics, clinical manifestations, laboratory results, ultrasound findings, and pathogens present in the AAC patients was also collected. Predictors of mortality were identified by association analyses and confirmed by multivariate logistic regression. RESULTS A total of 147 pediatric AAC patients (male/female = 1.01, mean age = 5.2 years) were included in this retrospective study. The most common clinical presentation was an elevated C-reactive protein level (84%) followed by hepatomegaly (80%) and anorexia (78%). AAC in children was associated with various diseases, including infectious diseases (70%), systemic diseases (13%), and malignancy (11%). Fourteen of the 147 (9.25%) patients died during the study period. The presences of thrombocytopenia, anemia, gallbladder sludge, hepatitis, and/or sepsis plus hepatitis were found to be the important predictors of AAC mortality. CONCLUSIONS The factors associated with AAC mortality were anemia, thrombocytopenia, gallbladder sludge, hepatitis, and sepsis plus hepatitis. These predictors are likely to help clinicians identify patients who are at a high risk of poor prognoses and make appropriate clinical decisions.
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Affiliation(s)
- Yi-An Lu
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Infectious Disease, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-I Wang
- Department of Health Sciences, University of York, York, England, UK
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chen CL, Chao HC, Kong MS, Chen SY. Risk Factors for Prolonged Hospitalization in Pediatric Appendicitis Patients with Medical Treatment. Pediatr Neonatol 2017; 58:223-228. [PMID: 27477876 DOI: 10.1016/j.pedneo.2016.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/02/2016] [Accepted: 02/26/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND With effective antibiotics against enteric flora and computed tomography-guided drainage for abscesses, the initial use of nonoperative therapy for children with appendicitis has increased both in recent reports and at our hospital. However, it has been reported that these patients have a relatively longer hospital stay and that their treatment is more expensive than those who undergo aggressive surgical intervention. METHODS This was a retrospective cohort study based in a single medical center. A systemic chart review was conducted to identify risk factors for prolonged hospitalization in pediatric appendicitis patients not initially undergoing surgical treatment. Patient demographics, clinical symptoms, duration of symptoms, laboratory findings, imaging findings, complications, and length of hospital stay were analyzed. Logistic regression analysis was used to identify significant predictors of prolonged hospitalization (≥15 days) and readmission. RESULTS One hundred and twenty-five patients were recruited in this study, of whom 53 (42.4%) had prolonged hospitalization. The values of serum C-reactive protein (CRP) were significantly higher in patients with prolonged hospitalization compared with those without prolonged hospitalization (203 ± 108.6 mg/L vs. 140 ± 93.0 mg/L, p = 0.001). Risk factors of prolonged hospitalization were serum CRP >150 mg/L (35/53 vs. 28/72, p = 0.001), abscess formation (38/53 vs. 35/72, p = 0.008), and multiple abscesses (10/53 vs. 1/72, p = 0.001). Under multivariate analysis, CRP >150 mg/L (odds ratio=1.004, p = 0.0334) and multiple abscesses (odds ratio = 8.788, p = 0.044) were two independent predictors for prolonged hospitalization. CONCLUSION Marked elevation of serum CRP (>150 mg/L) and multiple abscesses are two independent risk factors for prolonged hospitalization in children with appendicitis who are initially treated nonoperatively.
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Affiliation(s)
- Ching-Lun Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan; Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan.
| | - Man-Shan Kong
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan; Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan
| | - Shih-Yen Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, Guishan District, Taoyuan City, Taiwan; Chang Gung University College of Medicine, Guishan District, Taoyuan City, Taiwan
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Chen CC, Chen KJ, Kong MS, Chang HJ, Huang JL. Alterations in the gut microbiotas of children with food sensitization in early life. Pediatr Allergy Immunol 2016; 27:254-62. [PMID: 26663491 DOI: 10.1111/pai.12522] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND We hypothesized that food sensitization (FS) in children could be linked to specific gut microbiota. The aim of our study is to quantify and evaluate differences in gut microbiota composition between children with FS and healthy controls. METHODS A case-control study of 23 children with FS and 22 healthy children was performed. Individual microbial diversity and composition were analyzed via parallel barcoded 454 pyrosequencing targeting the 16S rRNA gene hypervariable V3-V5 regions. RESULTS The children with FS exhibited lower diversity of both the total microbiota (p = 0.01) and the bacterial phylum Bacteroidetes (p = 0.02). In these children, the number of Bacteroidetes bacteria was significantly decreased and that of Firmicutes were significantly increased compared with the healthy children. At the genus level, we observed significant increases in the numbers of Sphingomonas, Sutterella, Bifidobacterium, Collinsella, Clostridium sensu stricto, Clostridium IV, Enterococcus, Lactobacillus, Roseburia, Faecalibacterium, Ruminococcus, Subdoligranulum, and Akkermansia in the FS group. We also found significant decreases in the numbers of Bacteroides, Parabacteroides, Prevotella, Alistipes, Streptococcus, and Veillonella in this group. Furthermore, linear discriminant analysis (LDA) coupled with effect size measurements revealed the most differentially abundant taxa (increased abundances of Clostridium IV and Subdoligranulum and decreased abundances of Bacteroides and Veillonella), which could be used to identify FS. CONCLUSIONS Our results showed that FS is associated with compositional changes in the gut microbiota. These findings could be useful for developing strategies to control the development of FS or atopy by modifying the gut microbiota.
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Affiliation(s)
- Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kun-Jei Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Ju Chang
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jing-Long Huang
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Huang CC, Lai MW, Hwang FM, Yeh YC, Chen SY, Kong MS, Lai JY, Chen JC, Ming YC. Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol 2014; 55:369-75. [PMID: 24685339 DOI: 10.1016/j.pedneo.2013.12.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/13/2013] [Accepted: 12/09/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Our objective was to analyze demographics and characteristics of Meckel's diverticulum with different manifestations in pediatric patients. METHODS This is a retrospective study in children with symptomatic Meckel's diverticulum who underwent resection between September 1998 and October 2010. The diagnosis was confirmed by surgery and pathology. Demographic characteristics, manifestations, Meckel's scan results, surgical and histological findings were analyzed. RESULTS One hundred symptomatic Meckel's diverticula were identified in 74 boys and 26 girls aged from one day to 18 years old over 13 years. Depending on whether or not obstruction occurred, the patients were classified into two categories. Each category was further subdivided into two diagnostic groups: 17 intussusception and 24 non-intussusception bowel obstruction in the obstructive category and 44 gastrointestinal bleeding and 15 diverticulitis and/or perforation in the non-obstructive category. The sex discrepancy was higher in the non-obstructive category than in the obstructive category (male-to-female, 4.36 vs. 1.73, p < 0.05). Forty-one of 44 patients with gastrointestinal bleeding underwent a Meckel's scan with a high positive rate (92.7%). The ectopic tissues were identified in 73 patients and included 61 gastric type, two pancreatic type and 10 mixed type. Ectopic tissues were more prevalent in non-obstructive category (p < 0.05) with ectopic gastric tissue even more pronounced (p < 0.01). Ectopic pancreatic tissue was significantly more prevalent in intussusception (p < 0.01). Laparoscopic surgery was performed more frequently in Meckel's diverticulum with non-obstructive symptoms (p < 0.001). CONCLUSION Diverse presentations in pediatric Meckel's diverticulum are affected by different ectopic tissue types and male sex. Laparoscopic surgery is widely used for children with non-obstructive symptoms.
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Affiliation(s)
- Chen-Chuan Huang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Fang-Ming Hwang
- Department of Education, National Chiayi University, Chiayi, Taiwan
| | - Yu-Chen Yeh
- Institute of Education, National Chiao Tung University, Hsinchu, Taiwan
| | - Shih-Yen Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jeng-Chang Chen
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Ching Ming
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chen CC, Chang CJ, Lin TY, Lai MW, Chao HC, Kong MS. Usefulness of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea. World J Gastroenterol 2011; 17:4218-24. [PMID: 22072854 PMCID: PMC3208367 DOI: 10.3748/wjg.v17.i37.4218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/11/2011] [Accepted: 07/18/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the value of fecal lactoferrin in predicting and monitoring the clinical severity of infectious diarrhea.
METHODS: Patients with acute infectious diarrhea ranging from 3 mo to 10 years in age were enrolled, and one to three stool samples from each subject were collected. Certain parameters, including white blood cells /differential count, C-reactive protein, fecal mucus, fecal pus cells, duration of fever, vomiting, diarrhea and severity (indicated by Clark and Vesikari scores), were recorded and analyzed. Fecal lactoferrin was determined by enzyme-linked immunosorbent assay and compared in different pathogen and disease activity. Generalized estimating equations (GEE) were also used for analysis.
RESULTS: Data included 226 evaluations for 117 individuals across three different time points. Fecal lactoferrin was higher in patients with Salmonella (11.17 μg/g ± 2.73 μg/g) or Campylobacter (10.32 μg/g ± 2.94 μg/g) infections and lower in patients with rotavirus (2.82 μg/g ± 1.27 μg/g) or norovirus (3.16 μg/g ± 1.18 μg/g) infections. Concentrations of fecal lactoferrin were significantly elevated in patients with severe (11.32 μg/g ± 3.29 μg/g) or moderate (3.77 μg/g ± 2.08 μg/g) disease activity compared with subjects with mild (1.51 μg/g ± 1.36 μg/g) disease activity (P < 0.05). GEE analysis suggests that this marker could be used to monitor the severity and course of gastrointestinal infections and may provide information for disease management.
CONCLUSION: Fecal lactoferrin increased during bacterial infection and with greater disease severity and may be a good marker for predicting and monitoring intestinal inflammation in children with infectious diarrhea.
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Abstract
AIM To identify clinical, laboratory, and imaging characteristics associated with severe acute pancreatitis in children. METHODS This was a retrospective study of children under 18 years of age with acute pancreatitis between September 1993 and August 2008. Severity of pancreatitis was graded according to established criteria. Clinical, laboratory and radiological data for mild and severe pancreatitis were collected for analysis. RESULTS There were 180 cases of pancreatitis; 51 (28.3%) met criteria for severe disease. Severe pancreatitis was most commonly associated with systemic disease (22 of 51; 43.1%) and trauma (13 of 51; 25.4%). Patients with severe pancreatitis had significantly higher body weight, higher frequency of dyspnoea and pleural effusion, and lower serum calcium and albumin levels. Ten patients with systemic disease died; four of them had systemic lupus erythematosus (SLE). Computed tomography (CT) was more accurate than ultrasound in evaluation of the severity of pancreatitis. CONCLUSIONS Acute pancreatitis in children is associated with significant morbidity and mortality. The severity of paediatric pancreatitis may be influenced by aetiology. CT is recommended for evaluation of severity of pancreatitis.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tauyuan, Taiwan
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Chang YJ, Chao HC, Kong MS, Hsia SH, Yan DC. Misdiagnosed acute appendicitis in children in the emergency department. Chang Gung Med J 2010; 33:551-557. [PMID: 20979706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND To identify clinical features that distinguish children with appendicitis who visited the emergency department twice or more from those diagnosed on the first visit to the emergency department. METHODS A retrospective review of all children with appendicitis diagnosed in the emergency department between January and December 2004 was conducted. Records were reviewed for all patients on their initial presentation to the emergency department. Clinical features were compared between those children who were misdiagnosed and those who were diagnosed correctly. RESULTS One hundred seventy-three cases were included (mean age, 10.4 years). Twenty-six (15%) were seen twice or more in the emergency department before appendicitis was diagnosed. Misdiagnosed patients had a relatively shorter duration of symptoms at their initial visit, and most presented late at night. Eighteen misdiagnosed patients (69.2%) initially visited the emergency department within 24 hours of onset of symptoms. Compared with patients diagnosed correctly on initial presentation, misdiagnosed patients had a significantly shorter hospital stay, fewer laboratory tests, and fewer physical findings of right lower quadrant tenderness, muscle guarding, rebound tenderness, fever, and migrating pain. Patients diagnosed late at night had a significantly shorter hospital stay and fewer abdominal ultrasound evaluations. On final presentation, initially misdiagnosed patients had a higher rate of appendiceal perforation than did correctly diagnosed patients. CONCLUSION Misdiagnosed appendicitis is a problem in the emergency department. A shorter stay in the emergency department, fewer laboratory tests, less diagnostic imaging, and fewer physical findings may be responsible for misdiagnosed appendicitis late at night in the emergency department.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital at Taipei, Chang Gung University College of Medicine, Tauyuan, Taiwan
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Abstract
AIM: To investigate the immune response of peripheral blood mononuclear cells (PBMCs) and dendritic cells (DCs) that were stimulated by probiotic preparations.
METHODS: PBMCs were isolated, cultured, and stimulated with Bio-Three (a mixture of Bacillus mesentericus, Clostridium butyricum and Enterococcus faecalis; 105, 106 and 107 CFU/mL for 24 h). Cytokine production of (1) circulating PBMCs; (2) PBMCs stimulated by probiotic preparation; (3) monocyte-derived DCs; and (4) DC and T cell co-culture was determined by enzyme-linked immunosorbent assay. Phenotypic analysis of circulating PBMCs was also investigated by flow cytometry. Blood was obtained from individuals who consumed Bio-Three (109 CFU/d B. mesentericus, C. butyricum and E. faecalis) for 2 wk, or those who did not take probiotics orally.
RESULTS: In culture supernatants, interferon-γ (IFN-γ) and interleukin (IL)-10 production increased, but IL-4 and tumor necrosis factor-α (TNF-α) production by PBMCs decreased after 1 and 2 wk of probiotic treatment. Flow cytometry was also performed on day 14 and detected enhanced expression of CD11b, HLA-DR, CD4, CD45RA, CD25, CD44 and CD69 in response to Bio-Three. Furthermore, IL-10 and IL-12 were upregulated in supernatants of monocyte-derived DCs, and IFN-γ and IL-10 were enhanced in supernatants of CD4+ T cells co-cultured with DCs.
CONCLUSION: Bio-Three appeared to stimulate the Th1 immune response, downregulate pro-inflammatory cytokines (TNF-α) and upregulate anti-inflammatory cytokine (IL-10). Probiotics could be effective in activation of PBMCs and DCs.
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Hua MC, Chao HC, Lien R, Lai JY, Lai MW, Kong MS. The different clinical and liver pathological characteristics between the newborns and infants with choledochal cysts. Chang Gung Med J 2009; 32:198-203. [PMID: 19403010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND This study was undertaken to investigate the different clinical presentations of newborns and older infants with choledochal cysts, and their liver pathological changes. METHODS The medical records of patients who were diagnosed with choledochal cysts younger than 1 year old at our hospital from March 1991 through November 2006 were reviewed. Patients were divided into two groups: the newborn group, who presented before 1 month old including those antenatally diagnosed patients; and the infant group, who presented at 1 month to 12 months old. All of the patients' clinical data, including the operative, pathological reports and outcomes were studied and analyzed using the Chi-square and student-t tests. RESULTS There were 35 patients included in the study. According to the Todani's classification, 74.2% of choledochal cysts were type I. Using Chi-square and student-t tests, the infant group had significantly higher pre-operative morbidity, abnormal levels of serum transaminase, gamma trans-peptide (gamma-GT), and grade of liver fibrosis (>or=grade 2) (p<0.05). The post operative complications were not statistically significant between newborn and infant groups. CONCLUSION Both groups had favorable outcomes after surgical intervention. We suggest that surgical.
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Affiliation(s)
- Man-Chin Hua
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan
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15
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Abstract
The observation on the impact of constipation on nutritional and growth status in healthy children was never reported. During a 4-y period, we evaluated the consequence of constipation on growth in children. The enrolled children were aged between 1 and 15 y with constipation. Medical response of constipation to treatment was evaluated by the scoring of constipation symptoms. The correlation of therapeutic effect of constipation with growth status at 12 wk and 24 wk was statistically evaluated. About 2426 children (1284 boys, 1142 girls) with a mean age of 7.31 +/- 3.65 (range 1.1-14.9) y were enrolled. After 12-wk treatment, significant increase of z-scores of height-for-age, weight-for-age, and body mass index-for-age were all found in patients with good medical responses (1377 cases) than in those with poor medical responses (1049 cases). The 1049 patients with poor medical response received advanced medications; significant increase of z-scores of height-for-age, weight-for-age, and body mass index were also found in these patients. A marked increase of appetite was significantly correlated with better gain on height and weight after treatment. We conclude that chronic constipation may retard growth status in children, and a long-term medication for constipation in children appears beneficial to their growth status.
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Affiliation(s)
- Hsun-Chin Chao
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Kweishan, Taoyuan 33305, Taiwan.
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Chao HC, Lai MW, Kong MS, Chen SY, Chen CC, Chiu CH. Cutoff volume of dietary fiber to ameliorate constipation in children. J Pediatr 2008; 153:45-9. [PMID: 18571534 DOI: 10.1016/j.jpeds.2007.12.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 11/19/2007] [Accepted: 12/18/2007] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the proper ingested volume of dietary fiber for relieving constipation in children. STUDY DESIGN During a 3-year period, we prospectively evaluated the correlation of intake volume of dietary fiber with improvement of constipation in children. Patients were categorized into younger (3-7 years) and older (8-14 years) children. The evaluation period lasted 12 weeks. A good improvement was defined as the child exhibiting at least 60% relief of the constipation symptoms during the observation period. Freedom from constipation was observed during the last 4 weeks. RESULTS The study population consisted of 422 patients (213 younger, 209 older), with a mean age of 7.89 +/- 4.71 years. Baseline daily dietary fiber intake of the younger and older groups was 5.97 +/- 2.35 g and 9.83 +/- 3.51 g, respectively. 227 cases (53.8 %) showed improvement of constipation, and 49.1 % of the patients had relief of constipation. Greater intake of dietary fiber was positively associated with good improvement of constipation in both groups (P = .002, and P < .001). Cutoff volumes of daily dietary fiber intake in the relief of constipation were 10 g in the younger group and 14.5 g in the older group. CONCLUSION The cutoff of dietary fiber intake needed to relieve constipation increased with age, achievable in a 12-week intervention.
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Affiliation(s)
- Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Abstract
BACKGROUND The main topic of the current review is the usefulness of technetium-99m-labeled red blood cell scintigraphy ((99m)Tc RBC scan) in children with acute massive gastrointestinal (GI) bleeding. METHODS The medical records of pediatric patients who experienced massive GI bleeding and who underwent (99m)Tc RBC scanning between November 1991 and December 2004 were reviewed and analyzed retrospectively. RESULTS The study included 22 patients who underwent 23 (99m)Tc RBC scans. The scans were usually performed after other diagnostic tests failed to locate the bleeding. The diagnostic sensitivity of the scans was nine out of 23 (39.1%). The test demonstrated a positive scan within the first 2 h in six patients, and three patients had positive results at 24 h. The locations of the lesions identified on scanning and surgical investigation were highly correlated in patients with a positive scan within 2 h. CONCLUSIONS The (99m)Tc RBC scan is a sensitive, albeit non-specific, method for detecting GI bleeding. The location of a lesion as indicated by a positive scan within 2 h is helpful for guiding surgical intervention and angiography, although a definitive diagnosis should be made with other methods, particularly laparotomy.
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Affiliation(s)
- Jung Lee
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Lee J, Kong MS. Primary intestinal lymphangiectasia diagnosed by endoscopy following the intake of a high-fat meal. Eur J Pediatr 2008; 167:237-9. [PMID: 17453239 DOI: 10.1007/s00431-007-0445-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 02/07/2007] [Indexed: 12/18/2022]
Affiliation(s)
- Jung Lee
- Division of Paediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital, Graduate Institute of Clinical Medical Sciences Chang Gung University, 5 Fu-Hsin St. KueiShan, Taoyuan, Taiwan
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Abstract
BACKGROUND Although the detection of pediatric peptic ulcer disease (PUD) has recently been increasing, perforated peptic ulcer (PPU) in children is rare. We report our experience with PPU in children. MATERIALS AND METHODS The charts of children diagnosed with PPU at our hospital from January 1986 to June 2005 were reviewed. Data were obtained on demographics, coexisting clinical events, perforation sites, delay in surgery, operative findings and methods, and outcomes. The data were analyzed using the chi2, Student t test, and multivariate logistic regression for possible risk factors. RESULTS There were 42 male and 10 female patients aged 2 to 18 years (mean, 14.2 years) included in the study. Forty-seven patients were adolescents (90%). Eight patients had coexisting clinical events before PPU. All of the patients manifested acute abdominal pain. Forty-nine patients (94.2%) had peritoneal signs. Radiography showed subdiaphragmatic free air in 43 patients (82.7%); this was the most important tool for establishing diagnosis. Nine patients (17.3%) had postoperative complications. Two patients died (3.8%). Univariate analysis showed that poor outcome was significantly associated with female sex, more coexisting clinical events, no evidence of chronic ulcer, and treatment by simple suture (P < 0.05). Only female sex and simple suture remained statistically significant in multivariate analysis. Although delay in surgery (>12 hours) was not significantly related to complications, there was a greater tendency toward the development of complications. CONCLUSIONS PPU should be suspected in adolescents who manifest acute abdominal pain and have peritoneal signs. Children with PPU have a more favorable outcome than adults.
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Affiliation(s)
- Man-Chin Hua
- Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital, Taiwan
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Abstract
OBJECTIVE Acute appendicitis is an uncommon diagnosis in early childhood. It is frequently complicated by delays in diagnosis, perforation, and prolonged hospital stay. The aim of this study was to evaluate the usefulness of ultrasonography (US) in the management of suspected appendicitis in children younger than 3 years of age. PATIENTS AND METHODS Seventy-one children under age 3 with acute abdomen and possible acute appendicitis, but with atypical findings, were included. All of the children underwent a US scan to rule out appendicitis. RESULTS There were 41 positive US results for appendicitis. Three children had false-positive scan results and 2 children had false-negative results. Twenty-eight patients had ruptured appendicitis with tumor formation on US. Eighteen of the 28 patients received emergency appendectomy and the other 10 patients received initial conservative treatment with interval appendectomy. Compared with those who received emergency appendectomy, patients who received initial conservative treatment had a significantly smoother postoperative course, including shorter postoperative hospital stay and earlier postoperative oral intake. The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of abdominal US to diagnose acute appendicitis in cases of atypical findings in early childhood are 95.0%, 90.3%, 92.9%, 92.6%, and 93.3%, respectively. CONCLUSIONS US is a useful and highly accurate tool to assess acute appendicitis in early childhood. US has the potential to aid in diagnosis of early childhood appendicitis to avoid the frequent rupture with tumor formation seen at this age. Initial conservative treatment for ruptured appendicitis with tumor formation is safe and is associated with a smoother postoperative course in early childhood.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tauyuan, Taiwan
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Abstract
Commercially available double-channel endoscopes are designed mainly for adults. We present our experience of using a home-made pediatric double-channel endoscope. A feeding tube was attached to the side of a single-channel endoscope by adhesive tape. The attached tube was used as an additional working channel. Fifty-nine procedures, including esophageal variceal injection sclerotherapy, gastrointestinal bleeding, polypectomy, and foreign body removal, were successfully performed using this home-made double-channel endoscope. No complications were observed. This home-made double-channel endoscope is safe, efficient, and inexpensive for use in pediatric procedures.
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Affiliation(s)
- Man-Shan Kong
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chang Gung Children's Hospital, Linkou, Taiwan.
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Abstract
Colon perforation is an abdominal surgical emergency in the pediatric population, but is seldom reported when occurring from non-traumatic causes in children beyond the neonate. The goal of this study was to identify the clinical characteristics, management, and outcomes of non-traumatic colon perforation in children. Medical records for the 10-year period from September 1994 to September 2004 were reviewed for children beyond the neonate with non-traumatic colon perforation. Data gathered included age, gender, symptoms, duration of symptoms, physical findings, and length of postoperative hospital stay. Diagnostic information included laboratory data, radiographic imaging, and operative findings. Forty-four patients with non-traumatic colon perforation were recruited into this study. The mean age was 2.22 +/- 1.87 years; 91.4% of cases were younger than 5 years old. The most common presenting symptom was fever (97.7%); the most common sign was abdominal distention (93.1%). The mean duration of symptoms prior to admission was 6.19 days. Pneumoperitoneum was presented in 86.3% of patients by plain abdominal radiograph. Ascending and transverse colon were the most common perforation sites. Non-typhoid salmonella was the leading pathogen isolated, causing 20.4% of episodes. One case died due to Clostridium speticum infection. Non-traumatic colon perforation most commonly affects children younger than 5 years of age. It may be secondary to infection, especially non-typhoid salmonella. Plain abdominal radiograph can be an adjuvant tool for the high index of suspicion for colon perforation in children with abdominal distention and history of fever or diarrhea for more than 5 days.
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Affiliation(s)
- Y J Chang
- Department of pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine or Chang Gung Institute of Technology, Chang Gung Children's Hospital, Kwei-Shan, Taoyuan, Taiwan
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Yen JB, Kong MS. Gastric outlet obstruction in pediatric patients. Chang Gung Med J 2006; 29:401-5. [PMID: 17051838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND This study reports the etiologies, management and outcome of children with gastric outlet obstruction (GOO) in a children's hospital. METHODS The medical records of 11 children with GOO not associated with idiopathic hypertrophic pyloric stenosis (IHPS) were reviewed. They were categorized into one group of anatomic abnormality (AA group) and one group of peptic ulcer disease (PD group). One case underwent episodes of GOO caused by anatomic abnormality and peptic ulcer disease, respectively. RESULTS Six cases belonged to the AA group. Mean age was 58 months with a male to female ratio of two to four. Underlying etiologies were prepyloric mass (2), web (2) and gastric volvulus (2). Four patients underwent surgery. One patient was lost to follow-up. GOO did not recur in the follow-up period (mean duration 24 months) in the remaining cases. One case in the AA group and the remaining five patients composed the PD Group. Mean age was 49 months and all were male. Underlying causes were gastric ulcers (4) and chronic duodenal ulcers (2). Two of the five patients had Helicobacter pylori infection found by rapid urease test. Four patients recovered after medical management and another two, with normal serum gastrin levels, underwent surgery because of poor response to medical treatment. One case was lost to follow-up. No recurrence of GOO was noted in the follow-up period (mean duration 27 months) in the remaining cases. CONCLUSIONS In our study, peptic ulcer disease was as important as anatomic abnormalities as the etiology for GOO not associated with IHPS, and medical management could release GOO caused by it. Compared to adult patients, H. pylori infection played a less important etiologic role in pediatric patients with GOO.
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Affiliation(s)
- Ju-Bei Yen
- Department of Pediatrics, Chang Gung Memorial Hospital, 5 West, Chia-Pu Road, Putz City, Chiayi, Taiwan 613, ROC.
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Chen CF, Kong MS, Lai MW, Wang CJ. Acute pancreatitis in children: 10-year experience in a medical center. Acta Paediatr Taiwan 2006; 47:192-6. [PMID: 17180787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Acute pancreatitis is uncommon in children compared with adults. The purpose of this study was to evaluate the etiologies, clinical presentations, image findings and outcome of children's acute pancreatitis. METHODS The medical records of children and adolescent patients admitted due to pancreatitis from July 1992 to July 2002 were reviewed. The diagnosis of pancreatitis was based on clinical symptoms, at least threefold elevation of serum pancreatic enzymes, and image findings. RESULTS This study comprised 75 patients with 96 episodes of pancreatitis. There were 36 males and 39 females, with a mean age of 10 years. The leading etiologies were idiopathic (26.7%), systemic diseases (22.7%), biliary tract disease (21.3%), and trauma (16%). Common initial manifestations included abdominal pain (93.8%), vomiting (64.2%), and fever (33.3%). The sensitivities of ultrasonography (US) and computed tomography (CT) in detecting pancreatitis were 57.3% and 74.4%, respectively. The morbidity included 6 pseudocysts and 16 repeated pancreatitis. Four pseudocysts were resulted from traumatic pancreatitis. Patients with hyperlipidemia and biliary tract disorder were more likely to have repeated attacks. Fifty-five (73.3%) patients recovered after conservative management, the remaining 20 (26.7%) patients needed surgical or other interventional treatment. The mortality rate was 5.3%. Three fatal cases (75%) had underlying medical diseases. CONCLUSIONS The etiologies of acute pancreatitis are diverse. Abdominal CT is more sensitive than US in the diagnosis of pancreatitis. Pseudocysts are more likely to occur in patients with traumatic pancreatitis. Patients with hyperlipidemia are prone to recurrent pancreatitis. The prognosis of children's pancreatitis is good. Most patients with fatal outcome had coexistent medical diseases.
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Affiliation(s)
- Chiu-Fen Chen
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
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Chang MH, Chen THH, Hsu HM, Wu TC, Kong MS, Liang DC, Ni YH, Chen CJ, Chen DS. Prevention of hepatocellular carcinoma by universal vaccination against hepatitis B virus: the effect and problems. Clin Cancer Res 2006; 11:7953-7. [PMID: 16278421 DOI: 10.1158/1078-0432.ccr-05-1095] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE In spite of the success of hepatitis B immunization, still a significant proportion of childhood hepatocellular carcinoma (HCC) failed to be prevented by the hepatitis B immunization program. This study is aimed to investigate the problems in the HCC prevention in children. EXPERIMENTAL DESIGN All HCC children ages 6 to 14 diagnosed between 1981 and 2000 in Taiwan were collected from two national childhood HCC registry systems. We analyzed the causes of HCC prevention failure and the risk ratio of HCC among hepatitis B carriers born before versus after the vaccination program. RESULTS The incidence of HCC per 100,000 children declined from 0.54 to 0.20 in those born before versus after the vaccination program (risk ratio, 0.36). Vaccine failure (33.3-51.4%) and failure to receive hepatitis B immunoglobulin at birth (42.4-57.5%) were the main causes of HCC prevention failure. Mother-to-child transmission of hepatitis B virus infection is an important risk factor of HCC development. This is evidenced by the very high hepatitis B surface antigen seropositive rate in our HCC children (97%) and their mothers (96%). Hepatitis B carrier children born after the vaccination program had a higher risk of developing HCC than those born before the program (risk ratio, 2.3-4.5). CONCLUSIONS Vaccine failure and failure to receive hepatitis B immunoglobulin are the main problems preventing eradication of HCC. Hepatitis B carrier children born after the immunization program have a higher risk of developing HCC than those born before.
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Affiliation(s)
- Mei-Hwei Chang
- Department of Pediatrics, College of Medicine, National Taiwan University Hospital.
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Chang YJ, Lai MW, Kong MS, Chao HC. Accidental ingestion of Ecstasy in a toddler. J Formos Med Assoc 2005; 104:946-7. [PMID: 16607453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
Toddlers who ingest the drug of abuse 3,4-methylenedioxymethamphetamine (MDMA; 'Ecstasy') are at particularly high risk of serious neurological and cardiovascular side effects. We report of a 20-month-old male toddler who accidentally ingested Ecstasy. He presented with fever and seizures, tachycardia, hypertension, and hyperthermia. Urine amphetamine level was 2111 ng/mL. Treatment included rapid cooling, hydration, and support measures. Vital signs were regularly monitored. His condition became stable on day 2 and urine amphetamine level returned to normal on day 3 of hospitalization. His behavior, activity, and appetite had returned to their usual levels upon follow-up at our outpatient clinic. The incidence of drug abuse with MDMA has increased dramatically over the last decade in developed countries. It can be expected that accidental Ecstasy poisoning in children will increase as well. This case illustrates the need to consider the possibility of accidental Ecstasy ingestion in the differential diagnosis of a child suffering from convulsions with fever.
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Affiliation(s)
- Yi-Jung Chang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Kwei-Shan, Taoyuan, Taiwan
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Ni YH, Huang FC, Wu TC, Kong MS, Jeng YM, Chen PJ, Tsuei DJ, Chen HL, Hsu HY, Chang MH. Lamivudine treatment in maternally transmitted chronic hepatitis B virus infection patients. Pediatr Int 2005; 47:372-7. [PMID: 16091071 DOI: 10.1111/j.1442-200x.2005.02101.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lamivudine treatment in chronic carriers who acquired hepatitis B virus through maternal transmission were investigated. METHODS A total of 29 subjects (Male:Female, 24:5; mean age, 14.7 +/- 5.6 years) who were hepatitis B e antigen (HBeAg) seropositive for >6 months, alanine aminotransferase (ALT) was >1.3 times of upper limit of normal value, and receiving a 52 week-long treatment, received open-label lamivudine (3 mg/kg per day, maximum 100 mg/day). Another 29 subjects matched for gender, age, liver function, and HBeAg status followed up before the introduction of lamivudine served as the control group. The control group did not receive any treatment and were evaluated at week 52 after the onset of abnormal ALT. Mothers of all study subjects were hepatitis B surface antigen (HBsAg) carriers. A successful treatment response at week 52 was defined as: (i) undetectable hepatitis B virus DNA by real time polymerase chain reaction; (ii) normal ALT; and (iii) HBeAg/anti-HBe seroconversion. Lamivudine-resistant YMDD mutants were checked at week 52. RESULTS The lamivudine group did not reach a better successful treatment response rate than the control group (17 vs 10%, P = 0.44), except in patients with a baseline ALT >5 times of the upper limit of normal value. YMDD mutants developed in 34% of patients in the lamivudine group. CONCLUSION Lamivudine treatment is effective for maternally transmitted subjects with high ALT.
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Affiliation(s)
- Yen-Hsuan Ni
- Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan
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Chan PC, Chen HL, Kong MS, Huang FC, Lee HC, Lin CC, Liu CC, Lee IH, Wu TC, Wu SF, Ni YH, Hsu HY, Chang MH. Factors affecting the mortality of pediatric fulminant hepatic failure in relation to hepatitis B virus infection. J Gastroenterol Hepatol 2005; 20:1223-7. [PMID: 16048570 DOI: 10.1111/j.1440-1746.2005.03923.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM To investigate the factors affecting the outcome of fulminant hepatic failure (FHF) in children in relation to hepatitis B virus (HBV) infection. METHODS Retrospective review of a total of 94 cases (61 males and 33 females, aged from 1 month to 15 years) recruited from nine tertiary referral centers in Taiwan from 1985 to 1999. RESULTS The overall mortality rate was 75%. Patients in the mortality group were of an older age, had higher peak total bilirubin levels, a longer prothrombin time, and a lower percentage of HBV positivity (P < 0.001, P = 0.003, P = 0.0027 and P = 0.042, respectively). Mortality was 65% in the HBV positive (n = 42) and 83% in the HBV negative (n = 52) group (P = 0.05). In the HBV positive group, the prothrombin time was noted to be the single factor affecting outcome (P = 0.036). In the HBV negative group, older age and higher peak value of total serum bilirubin were suggestive of poor survival rate (P < 0.001 and P = 0.006, respectively). Multivariate analysis revealed that total bilirubin was the single factor affecting outcome in the HBV-negative group. The mortality rate of HBV positive children in three consecutive time periods without liver transplantation (1985-1989, 1990-1994, 1995-1999) decreased gradually (91, 67 and 38%, respectively, with P = 0.027). This change was not observed in HBV-negative cases. CONCLUSIONS Hepatitis B virus positive FHF had a lower mortality rate than HBV negative FHF, with each group having different factors affecting mortality.
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Affiliation(s)
- Pei-Chun Chan
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Chang YJ, Chao HC, Kong MS, Lai MW. Clinical analysis of disc battery ingestion in children. Chang Gung Med J 2004; 27:673-7. [PMID: 15605907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the characteristics, management, and outcomes of disc battery ingestion in children. METHODS We reviewed the medical records of children aged between 1 and 15 years old admitted to Chang Gung Children's Hospital due to disc battery ingestion from September 1997 through July 2003). The diagnosis of disc battery ingestion was based upon history, clinical symptoms, and results of imaging studies. The clinical data reviewed included sex, age, clinical manifestation, hospital course, imaging findings, and endoscopic results. RESULTS We found 12 cases (8 males and 4 females) of disc battery ingestion with a mean age of 1.8 +/- 3.43 years (range, 9 months to 5 years). Two patients had symptoms of vomiting, nausea, and abdominal pain. Two cases with no history of disc battery ingestion and were accidentally found by X ray studies. Four cases had their batteries impacted in the esophagus and eight cases had their batteries impacted in stomach. In those patients with esophageal impaction, one died suddenly, and the batteries were removed successfully by endoscope in the other three. Among those patients with batteries in the stomach, two patients underwent endoscope removal and the other 6 patients experienced smooth courses and the batteries spontaneously passed through the gastrointestinal tract within 5 days. The diameter of the ingested disc batteries ranged from 12 mm to 23 mm. The duration of hospitalization varied from 1 day to 61 days. Four patients had obvious damage of gastrointestinal mucosa including three esophageal mucosal erosion lesions, and one gastric mucosa erosion lesions with hemorrhage. Two patients experienced complications: one died suddenly due to tension in the pneumothorax and penumoperitoneum and the other had tracheoesophageal fistula. CONCLUSIONS Most cases of disc battery ingestion run uneventful courses. However, the ingestion of some disc batteries may be fatal or complicated with life-threatening events. If the battery impacts in the esophagus, emergency endoscopic management is necessary. Once in the stomach, the battery will usually pass through the gastrointestinal tract without long-term complications.
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Affiliation(s)
- Yi-Jung Chang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Fushing Street, Gueishan Shiang, Taoyuan, Taiwan 333, ROC
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Chen SY, Kong MS. Gastrointestinal manifestations and complications of Henoch-Schönlein purpura. Chang Gung Med J 2004; 27:175-81. [PMID: 15148994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Henoch-Schönlein purpura (HSP) is a systemic vasculitic disorder commonly affecting young children. Gastrointestinal (GI) involvement is frequently seen, and it varies from mild symptoms to severe complications. METHODS In the 5 years from July 1995 to June 2000, 208 children were diagnosed with HSP in our hospital. There were 116 males and 92 females with ages ranging from 9 months to 15 years (mean, 6.4 years; median, 5.5 years). Their medical records were reviewed. We focused on their gastrointestinal manifestations and complications. The hospital course and management of these patients were also analyzed. RESULTS GI manifestations were present in 162 cases (77.8%), and among them the most common presentation was colicky abdominal pain in 159 cases (98.1%), followed by vomiting in 64 cases (39.5%). Severe complications included massive GI bleeding in 5 patients, intussusception in 1, protein-losing enteropathy in 1, and a patient with pancreatitis. GI symptoms occurred before the manifestation of skin lesions in 41 patients (25.3%). Five of them underwent a laparotomy. Four cases were operated on due to suspicion of acute appendicitis or peritonitis. Another patient had an emergent operation due to ileo-ileo intussusception. CONCLUSIONS GI manifestations of HSP are common. Colicky abdominal pain was the most common GI manifestation of Henoch-Schönlein purpura. Some patients may have GI complications, but those requiring surgical intervention in our study were rare.
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Affiliation(s)
- Shih-Yann Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Hospital, Taipei
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Chen HL, Chang CJ, Kong MS, Huang FC, Lee HC, Lin CC, Liu CC, Lee IH, Wu TC, Wu SF, Ni YH, Hsu HY, Chen DS, Chang MH. Pediatric fulminant hepatic failure in endemic areas of hepatitis B infection: 15 years after universal hepatitis B vaccination. Hepatology 2004; 39:58-63. [PMID: 14752823 DOI: 10.1002/hep.20006] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To investigate the role of hepatitis B virus (HBV) infection in pediatric fulminant hepatic failure (FHF) after the launch of universal HBV vaccination, the authors analyzed the data from patients with FHF collected from a nationwide collaborative study group. Children aged 1 month to 15 years who were diagnosed with FHF (62 males and 33 females) between 1985-1999 were included. HBV infection (hepatitis B surface antigen [HBsAg] and/or immunoglobulin M hepatitis B core antibody [IgM anti-HBc] seropositive) accounted for 46% (43 of 95 cases) of all the cases of FHF. The average annual incidence of FHF in the time period 1985-1999 was 0.053/100,000 in the group of patients ages 1-15 years and 1.29/100,000 in those patients age < 1 year. Approximately 61% (58 of 95 cases) of all FHF cases were infants. The percentage of HBV infection was found to be higher in infants (57%) compared with children ages 1-15 years (27%) (P = 0.004). The incidence rate ratio of those patients age < 1 year to those ages 1-15 years was 54.2 for HBV-positive FHF and 15.2 for HBV-negative FHF. Maternal HBsAg was found to be positive in 97% of the infants with HBV-positive FHF, and hepatitis B e antigen (HBeAg) was found to be negative in 84% of these infants. Approximately 74% of all HBV-positive FHF patients and 81% of the infantile HBV-positive patients had been vaccinated. In conclusion, within the first 15 years of universal vaccination, HBV was found to rarely cause FHF in children age > 1 year but remained a significant cause of FHF in infants. HBV-positive FHF was prone to develop in infants born to HBeAg-negative, HBsAg-carrier mothers; these infants had not received hepatitis B immunoglobulin according to the vaccination program in place.
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Affiliation(s)
- Huey-Ling Chen
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
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Yen JB, Kong MS, Wu WJ, Huang CS, Chang KW. Idiopathic hypertrophic pyloric stenosis in identical twins. Chang Gung Med J 2003; 26:933-6. [PMID: 15008330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Idiopathic hypertrophic pyloric stenosis (IHPS) was thought to be a congenital disease traditionally, even though several published reports assumed IHPS was an acquired disease. The pathogenesis and inheritance patterns of IHPS are not fully understood. Except for the familial recurrence of IHPS, concordance of IHPS in monozygotic or dizygotic twins was also noted, but occurrence in female twins is rare. From July 1992 through June 2000, 130 patients were diagnosed with IHPS in our hospital including one pair of female twins. We present the finding in the twins and review the associated articles about the pathogenesis and inheritance patterns of IHPS.
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Affiliation(s)
- Ju-Bei Yen
- Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC.
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Luo CC, Kong MS, Chao HC, Wu WJ. Tension pneumoperitoneum following instrumental perforation of an obstructed esophagus in an infant. Chang Gung Med J 2003; 26:768-71. [PMID: 14717212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
A 4-month-old infant was diagnosed with esophageal atresia and tracheoesophageal fistula. He was admitted to our hospital because of progressive poor findings and repeated aspiration pneumonia after surgical repair. An esophagogram demonstrated severe esophageal stricture. Flexible endoscopic dilatation was performed under general anesthesia, but sudden onset respiratory distress and progressive abdominal distention were noted during the procedure. Abdominal radiographic study revealed severe pneumoperitoneum. Tension pneumoperitoneum after perforation of the obstructed esophagus is extremely rare but life threatening. We herein report our experience with the successful management of this complication in an infant.
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Affiliation(s)
- Chih-Cheng Luo
- Department of Pediatric Surgery, Chang Gung Children's Hospital, Taipei.
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Chen CC, Kong MS, Yang CP, Hung IJ. Hepatic hemangioendothelioma in children: analysis of thirteen cases. Acta Paediatr Taiwan 2003; 44:8-13. [PMID: 12800377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Hepatic hemangioendothelioma (HE) is a tumor that presents in infancy and toddler. It manifests hepatomegaly, abdominal mass, jaundice, abdominal distention, or high output cardiac failure. We reviewed patients with HE in our hospital in the past 15 years (from July 1986 to June 2001). The diagnosis was made by the histology specimen or various imaging studies. There were thirteen patients (9 males, 4 females) enrolled in our study. Their ages ranged from neonate to 2 years old. The common clinical manifestations included abdominal distention (53%), congestive heart failure (38.5%), abdominal mass (30.8%), jaundice (30.8%), and skin hemangioma (23.1%). Nine patients had serum alanine aminotransferase examination and were abnormal in 2. Anemia was noted in 7 of 13 (53.8%) patients, thrombocytopenia and hyperconsumptive coagulopathy were found in 4 and 5 patients, respectively. Serum alpha-fetoprotein was elevated in 4 of 7 patients. Abdominal ultrasonography (n = 13) showed heterogeneous and hypoechoic lesions in the liver. Computed tomography (n = 11) revealed central hypointensity with peripheral enhancement after contrast of the liver masses. Magnetic resonance imaging studies of the hepatic masses (n = 3) showed decreased signal intensity on T1 images and high signal intensity on T2. Most patients were treated with steroid. Other management included interferon, chemotherapy, embolization and/or surgery. Four patients were managed conservatively. Among the other nine patients, four patients died of sepsis, hepatic failure, disseminated intravascular coagulopathy or tumor rupture with hemorrhagic shock. HE appears to be a histologically benign tumor but may have a poor outcome because of complications. For its management, steroid is a first-line medication. Other methods of treatment were interferon, hepatic artery embolization, chemotherapy and surgery. Long term follow up is needed for the evaluation of treatment response.
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Affiliation(s)
- Chien-Chang Chen
- Department of Gastroenterology, Chang Gung Children's Hospital, No. 5, Fu-Hsin Street, Kuei-Shan, Taoyuan, Taiwan
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Wong AMC, Wong HF, Cheung YC, Wan YL, Ng KK, Kong MS. Duodenal duplication cyst: MRI features and the role of MR cholangiopancreatography in diagnosis. Pediatr Radiol 2002; 32:124-5. [PMID: 11819082 DOI: 10.1007/s00247-001-0600-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2000] [Accepted: 08/28/2001] [Indexed: 02/07/2023]
Affiliation(s)
- Alex Mun-Ching Wong
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, 5 Fu Hsing Street, Kwei Shan Hsing, Tao Yuan Hsien, Taiwan, R.O.C.
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Jaing TH, Huang CS, Chiu CH, Huang YC, Kong MS, Liu WM. Surgical implications of pseudomonas aeruginosa necrotizing fasciitis in a child with acute lymphoblastic leukemia. J Pediatr Surg 2001; 36:948-50. [PMID: 11381435 DOI: 10.1053/jpsu.2001.23998] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Necrotizing fasciitis caused by Pseudomonas aeruginosa is extremely rare. Only 4 cases were reported in the literature. The authors report the occurrence of P aeruginosa necrotizing fasciitis starting out as a vulval abscess in a girl before induction chemotherapy for acute lymphoblastic leukemia. To our knowledge, this is the second case described in association with leukemia. In this case, the outcome was favorable because of early surgical intervention, confirming the diagnosis. J Pediatr Surg 36:948-950.
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Affiliation(s)
- T H Jaing
- Division of Pediatric Hematology and Oncology, Department of Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Lin SL, Kong MS. Extremely low sodium hypotonic rehydration solution for young children with acute gastroenteritis. Chang Gung Med J 2001; 24:294-9. [PMID: 11480325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND The clinical efficacy and safety of a low-sodium hypotonic oral rehydration solution (LSORS) was compared in a pilot study with that of a standard World Health Organization oral rehydration solution (STORS) in young children with acute diarrhea. METHODS One hundred and seventeen boys aged 3 to 18 months with acute diarrhea were randomly assigned to groups and received low-sodium (sodium 28 mmol/L) hypotonic oral rehydration solution and standard oral rehydration solution (sodium 90 mmol/L). Outcomes of therapy such as stool volume, duration of diarrhea and fluid intake were recorded at 24 hours, 48 hours, and the discontinuation of disease. Serum electrolytes levels were calculated before and after therapy. RESULTS The stool output (gm/kg) in the first 24 hours was 69.2 +/- 38.5 in the LSORS group versus 105 +/- 39.8 in the STORS group (p < 0.05), while the total stool output during the 48-hour period was 151.4 +/- 68.9 in the LSORS group versus 232 +/- 97.3 in the STORS group (p < 0.05). No significant (p > 0.05) reduction in duration of diarrhea was noted (72.3 +/- 25.5 hours versus 69.8 +/- 29.4 hours). Four patients in the LSORS group and 7 patients in the STORS were classified as treatment failure. Forty-four (80%) achieved successful treatment in the LSORS group and 34 (56.7%) in the STORS group (p = 0.07). CONCLUSION LSORS is as safe as STORS in treating young children with acute gastroenteritis. No evidence of hyponatremia was found after patient received LSORS. LSORS afforded more efficacious therapy than STORS.
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Affiliation(s)
- S L Lin
- Department of Pediatrics, Chang Gung Memorial Hospital, 222, Mai-Chin Road, Keelung, Taiwan, R.O.C
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Lui KW, Wong HF, Cheung YC, See LC, Ng KK, Kong MS, Wan YL. Air enema for diagnosis and reduction of intussusception in children: clinical experience and fluoroscopy time correlation. J Pediatr Surg 2001; 36:479-81. [PMID: 11227001 DOI: 10.1053/jpsu.2001.21604] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The objective of this study was to correlate the fluoroscopy time with radiologic outcome in the pneumoreduction of intussusception in children. METHODS From September 1995 to December 1997, a prospective analysis of 181 cases of pediatric intussusception with pneumoreduction without sedation was done. A receiver operating characteristic curve of fluoroscopy time was drawn for correlation with radiologic outcome. RESULTS The overall success and failure rates of pneumoreduction were 84% and 16%, respectively. Three patients (1.6%) experienced colon perforation. The mean fluoroscopy time was 2.8 +/- 1.7 minutes in successful procedure and 4.9 +/- 2.8 minutes in failed procedures (P < 0.001). Analysis of the receiver operating characteristic curve of fluoroscopy time indicates that 4 minutes fluoroscopy time was a good critical point in differentiating successful and failed cases. In those 18 patients who had successful reduction with fluoroscopy times of more than 4 minutes, 4 patients had clinical symptoms for more than 1 day and 14 patients less than 1 day. One of those 4 patients required operation 1 day later because of peritonitis caused by necrosis of terminal ileum. Two patients had high fever in the next 2 days and recovered after antibiotic treatment. CONCLUSIONS Pneumoreduction is a good method in treatment of intussusception with high successful rate. Four minutes is the critical point of procedure. Reduction with greater than 4 minutes in those patients having illness more than 1 day might not benefit and have more complications.
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Affiliation(s)
- K W Lui
- First Department of Diagnostic Radiology, Chang Gung Medical Center, Chang Gung University, Tao-Yuan Hsien, Taiwan
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Abstract
CONTEXT Hepatocellular carcinoma (HCC) has a male predominance and is closely related to hepatitis B virus (HBV) infection. Hepatitis B virus vaccination was launched in 1984 in Taiwan for neonates of mothers carrying hepatitis B e antigen, resulting in a decreased incidence of HCC in children. The effect on boys vs girls is not known. OBJECTIVE To evaluate the association between a HBV vaccination program with incidence of childhood HCC by sex. DESIGN AND SETTING Analysis of data collected from Taiwan's National Cancer Registry System and the Taiwan Childhood Hepatoma Study Group between 1981 and 1996. PARTICIPANTS Children aged 6 to 14 years who were diagnosed as having HCC (201 boys and 70 girls). MAIN OUTCOME MEASURE Incidence of HCC in boys and girls before and after implementation of the vaccination program. RESULTS The boy-girl incidence ratio decreased steadily from 4.5 in 1981-1984 (before the program's introduction) to 1.9 in 1990-1996 (6-12 years after the vaccination program was launched). The incidence of HCC in boys born after 1984 was significantly reduced in comparison with those born before 1978 (relative risk [RR], 0.72; P =.002). No significant decrease in HCC incidence was observed in girls born in the same periods (RR, 0.77; P =.20). The incidence of HCC in boys remained stable with increasing age, while an increase of HCC incidence with age in girls was observed. These age and sex effects remained the same regardless of birth before or after the vaccination program. CONCLUSION Our results suggest that boys may benefit more from HBV vaccination than girls in the prevention of HCC.
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Affiliation(s)
- M H Chang
- Department of Pediatrics, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, Taiwan, Republic of China.
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Abstract
BACKGROUND To evaluate the risk factors for intestinal perforation in children with toxic megacolon caused by non-typhi Salmonella infection. METHODS During an 11-year period we reviewed the records of children treated for non-typhi Salmonella infection. All of the subjects had positive stool culture for non-typhi Salmonella and were treated with intravenous ceftriaxone during hospitalization. Clinical data reviewed included demographic features, clinical manifestations, laboratory findings, radiologic findings, microbiology, therapeutic effect of hydration and rectal tube placement and the operative findings. Patients with toxic megacolon were defined as those having toxic appearance, diarrhea, high fever (>39 degrees C) and marked colon dilatation with maximal diameter > 1.5 times the width of the vertebra body of the first lumbar spine (L1-VB). To define the risk factors for patients with toxic megacolon complicated by intestinal perforation, patients were divided into two groups for analysis: P group, those complicated with intestinal perforation; and NP group, those without intestinal perforation. Differences in age, sex, severity of diarrhea, duration of fever, hemogram and its differential, culture, stool analysis, serum C-reactive protein (CRP), electrolytes, maximal colon diameter, medical therapy and timing of rectal tube insertion between the two groups were analyzed. Statistical analyses were conducted with chi square tests and multiple logistic regression. RESULTS A total of 75 patients (P group, 27 patients; NP group, 48 patients) ages 4 months to 6 years were evaluated. With chi square analysis 7 variables were found to be significantly associated with intestinal perforation: age >1 year; fever >5 days; ratio of immature to total neutrophils >20%; serum CRP >200 mg/l; colon diameter >2.5 times the width of L1-VB; inadequate early hydration; and delay in rectal tube insertion. With multivariate analysis age >1 year, serum CRP >200 mg/l and colon diameter >2.5 times of width of L1-VB, inadequate early hydration and delay in rectal tube insertion were the most significant factors associated with intestinal perforation. CONCLUSION Identification of patients with toxic megacolon associated with non-typhi Salmonella infection at risk for further intestinal perforation is possible. Early effective fluid resuscitation and rectal tube insertion may be helpful to prevent the occurrence of intestinal perforation.
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Affiliation(s)
- H C Chao
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
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Chang KW, Lin SJ, Hsueh C, Kong MS. Menetrier's disease associated with cytomegalovirus infection in a child. Acta Paediatr Taiwan 2000; 41:339-40. [PMID: 11198943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Menetrier's disease is a rare disease with unknown etiology characterized by protein-losing hypertrophic gastropathy and hypoproteinemia. We report on a 4-year-old boy who presented with a 2-week history of vomiting and periorbital edema. Upper gastrointestinal endoscopy revealed prominent gastric rugae, while pathological examination showed hyperplastic mucosa with proliferation, elongation, and basal cystic dilatation of the gastric glands replaced by mucous-secreting epithelium, confirming the diagnosis of Menetrier's disease. Virus isolation from urine revealed cytomegalovirus (CMV); and CMV immunoglobulin G and immunoglobulin M antibodies were detected in the serum. His condition gradually improved under omeprazole, with complete histological recovery after 3 months.
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Affiliation(s)
- K W Chang
- Division of Pediatric Gastroenterology, Chang Gung Children's Hospital, No. 5, Fushing St., Kweishan 333, Taoyuan, Taiwan
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Chao HC, Lin SJ, Kong MS, Luo CC. Sonographic evaluation of the pancreatic duct in normal children and children with pancreatitis. J Ultrasound Med 2000; 19:757-763. [PMID: 11065264 DOI: 10.7863/jum.2000.19.11.757] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We investigated the diameter of pancreatic duct using ultrasonography in 51 children with pancreatitis and age-matched healthy control children over a 5 year period. The diameters of pancreatic duct and pancreatic body were measured simultaneously by sonography. The mean ages of children with acute pancreatitis and chronic pancreatitis were 9.7 +/- 3.9 and 10.3 +/- 3.1 years, respectively (range, 1 to 8 years). The mean age of normal children was 9.6 +/- 5.3 years. A significant difference was found in diameter of the pancreatic duct between children with acute and chronic pancreatitis versus that of age-matched control. In addition, a significant difference in diameter of the pancreatic body was found between children with acute pancreatitis and age-matched controls, but there was no marked difference in diameter of the pancreatic body between normal persons and those with chronic pancreatitis. The mean diameters of the pancreatic duct in acute pancreatitis and chronic pancreatitis were 2.34 +/- 0.47 mm and 2.84 +/- 0.67 mm, respectively, which was greater than that of normal children (1.65 +/- 0.45 mm). Pancreatic ducts with diameters greater than 1.5 mm in children between 1 and 6 years, greater than 1.9 mm at ages 7 to 12 years, or greater than 2.2 mm at ages 13 to 18 years were significantly associated with the presence of acute pancreatitis. Thirty-two patients, including 25 with acute pancreatitis and 7 with chronic pancreatitis, underwent follow-up measurement of pancreatic duct and serum lipase examination on at least three occasions. A good correlation between the diameter of pancreatic duct and serum lipase level was found. Thus, ultrasonography of the pancreatic duct is valuable in diagnosis and monitoring of pancreatitis in children.
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Affiliation(s)
- H C Chao
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Chang KW, Hou JW, Lin SJ, Kong MS. Alstrom syndrome with hepatic dysfunction: report of one case. Acta Paediatr Taiwan 2000; 41:270-2. [PMID: 11100527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Alstrom syndrome is a rare autosomal recessive disorder associated with early childhood retinopathy, progressive sensorineural hearing loss, truncal obesity, and acanthosis nigricans. We report a 10-year-old boy with Alstrom syndrome presenting with general malaise and abnormal liver function for 1 year. In addition to the above mentioned features, he also had hyperglycemia and hyperinsulinemia. The mechanism responsible for the persistent elevation of liver enzymes could not be identified. To the best of our knowledge, this is the first-reported case of Alstrom syndrome with hepatic dysfunction in Taiwan.
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Affiliation(s)
- K W Chang
- Department of Pediatric Gastroenterology, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Abstract
Premedication with intramuscular dexamethasone may decrease the rate of early recurrent intussusception by amelioration of lymphoid hyperplasia.
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Abstract
This 3 year prospective study evaluated the sensitivity and specificity of abdominal ultrasonography and color Doppler ultrasonography in 31 neonates with suspected malrotation or malrotation with volvulus. Water instillation was used to detect duodenal dilatation, edema, and malrotated bowels. Twenty patients with ultrasonographic characteristics of inversion of the superior mesenteric artery and superior mesenteric vein were later surgically proved to have malrotation. Nine of these 20 patients also had volvulus. Sonographic features suggestive of volvulus included duodenal dilation with tapering configuration (8 of 9 cases, 89%), fixed midline bowel (8 of 9 cases, 89%), whirlpool sign (8 of 9 cases, 89%), and dilation of the distal superior mesenteric vein (5 of 5 cases, 100%). The sensitivity and specificity of duodenal dilation with tapering configuration for detecting volvulus were 89% and 92%, respectively; of fixed midline bowel, 89% and 92%; of whirlpool sign, 89% and 92%; and of dilation of distal superior mesenteric vein, 56% and 73%. The results of this study indicate that ultrasonographic features of inversion of the superior mesenteric artery and superior mesenteric vein could aid in the diagnosis of malrotation, and certain sonographic features can also be used to evaluate volvulus, a condition requiring emergent operation.
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Affiliation(s)
- H C Chao
- Division of Gastroenterology, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Chao HC, Kong MS, Lin SJ, Lou CC, Lin PY. Papillary cystic neoplasm of the pancreas in children: report of three cases. Acta Paediatr Taiwan 2000; 41:101-5. [PMID: 10927949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Papillary cystic neoplasm of the pancreas is very rare in children. There were only 35 pediatric cases reported in the literature. We herein three children who had papillary cystic neoplasm of pancreas. They were female teenagers, and were pathologically diagnosed. The major presenting symptoms were abdominal pain and abdominal mass. Serum tumor markers of these patients showed normal results. A CT scan of these patients showed that this tumor was of pancreatic origin. These 3 tumors were localized to head, body, and tail, respectively. The mean maximal diameter of these tumors was 11.3 +/- 3 cm. Sonography and CT examination showed that the tumor was a heterogeneous mass with solid and cystic components. Angiography of this tumor showed a hypervascular mass with blood supply mainly from pancreatic branch of splenic artery. They all underwent tumor resection. All tumors contained some degree of internal hemorrhage or cystic degeneration and all were well encapsulated. Histologically, tumor cells generally showed solid and pseudopapillary growth around the fibrovascular stalks. No metastasis, mortality or recurrence was noted during follow-ups. In conclusion, CT scan helps to make a prospective diagnosis of papillary cystic neoplasm of pancreas. Our study confirmed that a papillary neoplasm of the pancreas is a low-grade malignant tumor. Surgical resection of the tumor is the mainstay of effective management.
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Affiliation(s)
- H C Chao
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
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Chao HC, Kong MS, Lin SJ. Hepatobiliary involvement of Henoch-Schönlein purpura in children. Acta Paediatr Taiwan 2000; 41:63-8. [PMID: 10927941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Hepatobiliary manifestation and its evolution in children with Henoch-Schönlein purpura (HSP) had been scarcely reported. Over a ten-year period between June 1988 and November 1998, medical charts of 225 children with the diagnosis of HSP encountered at Chang Gung Children's Hospital were reviewed. Those with the evidence of hepatobiliary involvement were enrolled in the study. The patients with hepatobiliary involvement were defined by having an elevated serum alanine transaminase (ALT) or gamma-glutamyl transferase (GGT), and the presence of abnormal sonographic findings involving liver, biliary system, and gallbladder. The patients included 9 boys and 11 girls with range of age from 3 to 11 years. The mean age of these patients was 6.5 +/- 3.7 years. Preceding upper respiratory tract infection was common in these patients (35%). The main clinical manifestation were distinct from typical abdominal symptoms of HSP, and included right upper quadrant pain (80%), nausea (45%), lethargy (20%), and vomiting (15%). Elevated serum ALT was noted in 15 cases (75%) and GGT in 6 cases (30%). Abdominal ultrasonography revealed hepatomegaly (15/20, 75%), and gallbladder wall thickening (5/20, 25%). No specific laboratory parameters were correlated with the hepatobiliary manifestation of HSP. Fourteen children (70%) received steroid therapy and disappearance of symptoms and sonographic resolution of hepatobiliary lesion was noted within 3-7 days of steroid therapy. All patients recovered completely except for one patient with hepatobiliary recurrence manifested as purpuric rash, abdominal pain, elevated GGT, and gallbladder wall thickening during 2-year follow-up.
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Affiliation(s)
- H C Chao
- Department of Pediatrics, Chang Gung Children Hospital, Taoyuan, Taiwan.
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Chao HC, Kong MS, Lin SJ, Huang JL. Gastrointestinal manifestation and outcome of Henoch-Schonlein purpura in children. Chang Gung Med J 2000; 23:135-41. [PMID: 15641216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND We reviewed the clinical and laboratory manifestations and analyzed the outcome in children with Henoch-Schönlein purpura (HSP) and gastrointestinal involvement. METHODS The medical records of 158 children who had Henoch-Schönlein purpura with gastrointestinal (GI) involvement admitted to our institution from June 1987 to December 1998 were reviewed. We retrospectively analyzed their demographic features, clinical manifestations, and outcome. RESULTS Totally 104 boys and 54 girls (male: female = 1.9:1) were enrolled in this study, with a mean age of diagnosis of 5.8+/-4.8 years (range: 2 to 13 years). Sixty-three (40%) of our patients had preceding upper respiratory tract infection. The main GI manifestations included abdominal pain (88%); GI bleeding (75%), and vomiting (25%). Bowel edema was found in 71% of examined patients. Upper GI endoscopy provided supportive evidence of HSP in 58% of patients examined. Five patients were found to have marked jejunal edema with bowel collapse leading to severe intestinal obstruction. Thirteen patients (8.2%) had emergent complications including massive blood loss from GI tract in 4, seizure in 2, severe hypoalbuminemia in 2, and emergent surgical condition in 6. Twenty-one patients (13%) experienced prolonged hospitalization (> or =10 days). Bilious vomiting, hematemesis, leukocytosis (>20000/cmm), high C-reactive protein (>50 mg/l), and hemorrhagic erosive duodenitis were found to correlate with prolonged hospitalization. Fourteen (20%) of 70 patients who received follow-up for more than 5 years experienced GI recurrence of HSP. CONCLUSION Despite severe and protracted GI symptoms in some HSP patients, the overall prognosis of GI involvement in children with HSP remains good.
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Affiliation(s)
- H C Chao
- Division of Gastroenterlogy, Department of Pediatrics, Chang Gung Children Hospital, Taipei
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Feng FH, Kong MS. Congenital esophageal stenosis treated with endoscopic balloon dilation: report of one case. Acta Paediatr Taiwan 1999; 40:351-3. [PMID: 10910549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Congenital esophageal stenosis is a narrowing of esophageal lumen that is present at birth, and may be asymptomatic in the neonate. Stenosis of the lower esophagus is a very rare form of esophageal obstruction. Three types of congenital esophageal stenosis have been described: fibromuscular stenosis, membranous webs, and tracheobronchial remnants. Fibromuscular stenosis and membranous webs respond to dilation, but must be distinguished from strictures caused by peptic esophagitis. Tracheobronchial remnants generally require surgical therapy. We report a 5-year-old girl with congenital esophageal stenosis, who presented with persistent dysphagia and poor weight gain. An esophagogram showed stricture of lower esophagus with proximal dilatation above esophagogastric junction. She was successfully treated with endoscopic balloon dilation.
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Affiliation(s)
- F H Feng
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Ng KK, Wong HF, Kong MS, Chiu LC, Tan CF, Wan YL. Biliary ascariasis: CT, MR cholangiopancreatography, and navigator endoscopic appearance--report of a case of acute biliary obstruction. Abdom Imaging 1999; 24:470-2. [PMID: 10475930 DOI: 10.1007/s002619900542] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A case of acute common bile duct obstruction caused by a roundworm in a 6-year-old girl is reported. Computed tomography (CT) and magnetic resonance imaging (MRI) showed "bull's-eye" and "eye-glass" appearances of the ascaris in the common bile duct. On reformation of the transverse CT and coronal MR images, the tubular Ascaris was better depicted. MRI and navigator endoscopic demonstrations of the common bile duct ascaris have not been described previously in the literature. These CT and MRI findings may be helpful in the diagnosis of Ascaris.
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Affiliation(s)
- K K Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Lin-Kou, 5 Fu-Hsing Street, Kwei-Shan Hsiang, Tao-Yuan Hsien, Taiwan, Republic of China
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