With the increasing use of magnets in toys, magnet ingestion is becoming a serious problem in children. Two or more magnets may attract across the gastrointestinal tract leading to pressure necrosis, perforation, fistula, volvulus or obstruction. We report a case of a 12-year-old boy with autism who presented with vomiting during seven days due to ingestion of 14 magnetic rods. Under general anesthesia, 5 of 14 magnets were removed from the second portion of the duodenum using a magnetic probe during endoscopy. The remaining magnets were not visible in the duodenum. A plain radiograph taken the next day revealed that the remaining magnets were impacted in the descending-sigmoid junction. One magnet passed spontaneously. However the other 8 magnets did not pass through the junction for 7 days. Five of 8 impacted magnets were removed by a colonoscopic procedure. After 2 hours of colonoscopy, one by one, the remaining three magnets spontaneously passed.
Anesthesia, General ; Autistic Disorder ; Child ; Colonoscopy ; Duodenum ; Eating ; Endoscopy ; Endoscopy, Gastrointestinal ; Fistula ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Intestinal Volvulus ; Magnetics ; Magnets ; Necrosis ; Play and Playthings ; Vomiting

PURPOSE: To evaluate current complementary feeding and maternal nutritional knowledge of a multicultural family in Korea. METHODS: Foreign mothers of babies aged 9~24 months, who visited pediatric clinics or attended a meeting on a multicultural family party between December 2010 and April 2011, were asked to fill out questionnaires. Data from 146 questionnaires were analyzed. RESULTS: Complementary food was introduced at 4~7 months in 78% of babies. The following were the sources of information on complementary feeding: friends (34%), relatives (27%), books/magazines (19%), multicultural family educational support center (8%), mass media (4%), and hospitals (3%). The cases of complementary food introduction after 8 months (21% vs. 10%, p<0.001), initial use of commercial food (26% vs. 6%, P<0.001) and initial use of bottle feeding (15% vs. 3%, p<0.001) were more frequent compared to the 2009 Korean survey. Mothers agreeing with the following suggestions were relatively fewer: feeding minced meat from 6~7 months (61%), No mixed cereal powder as complementary food (61%), feeding egg white after 12 months (63%), no adding salt or sugar to the complementary food (64%), bottle weaning before 15~18 months (66%) and considering formula better than soy milk (68%). CONCLUSION: Complementary feeding practices of multicultural families showed many points of improvement compared with the 2009 Korean survey. Pediatricians should make more of an effort to consult with families of multicultural infants about nutrition and complementary feeding. Also, the government and the pediatrics academy need to institute policies to support the nutrition of multicultural infants.
Aged ; Bottle Feeding ; Edible Grain ; Egg White ; Friends ; Humans ; Infant ; Infant Nutritional Physiological Phenomena ; Mass Media ; Meat ; Mothers ; Pediatrics ; Surveys and Questionnaires ; Soy Milk ; Weaning

PURPOSE: The aim of this study was to determine the prevalence, types of variants, and clinical significance of mutations in precore, core promoter, and "a" determinant mutations in children with chronic hepatitis B virus infection. METHODS: Thirty-one patients with chronic hepatitis B virus infection who visited Seoul National University Children's Hospital in Korea between 2004 and 2005 were enrolled in this study. Serum HBV DNA was amplified by polymerase chain reaction (PCR) and the precore/core promoter and "a" determinant sequences were determined. RESULTS: Precore mutations were found in 11 of 27 patients (40.7%), and appeared more frequently in the HBeAg-negative group (p<0.05) compared to the HBeAg-positive group. G1896A was detected most frequently (81.8%). BCP mutations were found in 15 of 27 patients (55.6%) and the TA mutation (A1762T/G1764A) was the most common (86.7%). Mutations in the "a" determinant region were detected in 8 of 28 patients (28.6%), and amino acid changes were detected in 6 of 28 patients (21.4%). Of these mutations, substitutions at amino acid position 126 were found most frequently. CONCLUSION: In children with chronic hepatitis B virus infection, the most common mutations were G1896A in the precore region and TA mutation(A1762T/G1764A) in the core promoter region. Substitutions at amino acid position 126 was the most common mutation in the "a" determinant. Precore mutants were found to be significantly higher in HBeAg-negative patients. The high prevalence of mutations in the "a" determinant and low frequency of G145R were characteristic features. These mutations were not significantly associated with other clinical features except for high aminotransferase concentration in the core promoter variant group.
Child ; DNA ; Hepatitis ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Korea ; Polymerase Chain Reaction ; Prevalence ; Promoter Regions, Genetic ; Viruses

PURPOSE: The aim of this study was to investigate the existence of TNF-alpha polymorphisms in Korean children with Crohn's disease (CD), ulcerative colitis (UC), as compared to healthy controls. METHODS: Blood samples were obtained from 40 patients with CD, 14 patients with UC, and 30 healthy controls. Genotyping for 5 TNF-alpha polymorphisms (G238A, G308A, C857T, C863A, and T1031C) was performed. The allele frequencies for the inflammatory bowel diseases, CD and UC, were measured in patients with these disease and in healthy controls, and these allele frequencies were compared between the 3 groups. We examined the significant association between polymorphism and disease phenotype, such as location, behavior, perianal disease, and pediatric Crohn's activity index (PCDAI) in CD. RESULTS: Based on our findings, the TNF-alpha allele frequencies of G238A, G308A, C857T, C863A, and T1031C were 3.3, 8.3, 16.7, 16.7, 21.7% in healthy control, 2.5%, 7.5%, 18.8%, 20.0%, 22.5% in CD, 7.1%, 7.1%, 7.1%, 21.4%, 28.6% in UC. They were no statistically significant differences between the 3 groups. There were no associations between genotypes and phenotypes in CD, except a statistically significant higher allele frequency of G238A in ileal type (L1) disease (p=0.010). CONCLUSION: Our results indicate that 5 TNF-alpha polymorphisms do not seem to be associated with susceptibility to inflammatory bowel disease in Korean pediatric patients even though young patients were anticipated to have a stronger genetic affiliation for these diseases than adult patients. We think that further studies are needed to find those genes associated with susceptibility to CD and UC in Korean pediatric patients with inflammatory bowel disease.
Adult ; Child ; Colitis, Ulcerative ; Crohn Disease ; Gene Frequency ; Genotype ; Humans ; Inflammatory Bowel Diseases ; Phenotype ; Tumor Necrosis Factor-alpha

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

PURPOSE: This study evaluated the efficiency and safety of the Foley catheter for esophageal removal of coins in children, compared to standard endoscopic extraction with respect to success rate, sedation, promptness and cost. METHODS: Twenty four children with coin lodgement in esophagus were managed with either a Foley catheter (n=14) or endoscopic extraction (n=10) from January 2007 through August 2010 at Kyungpook National University Hospital. A retrospective review of medical records and radiological findings was performed. RESULTS: Of the 14 patients who underwent Foley catheter extraction, successful and complication-free removal was achieved in 10 cases (71.4%). Of the 10 patients who underwent endoscopic extraction, all cases were successful (p=0.114). Sedation rate in the Foley catheter and endoscopic extraction group was 6/14 and 10/10 (p=0.006). The average wait time before the procedure and average hospital charge (US$) were 2.0+/-1.1 hours and 18.1+/-13.7 hours, and $113 and $428 for Foley catheter extraction and endoscopic extraction, respectively. CONCLUSION: Foley catheter extraction may be tried for the removal of esophageal coins in uncomplicated children. The technique is effective, safe, inexpensive and free of general anesthesia.
Anesthesia, General ; Catheters ; Child ; Endoscopy ; Esophagus ; Hospital Charges ; Humans ; Medical Records ; Numismatics ; Retrospective Studies

Ultrasonographic examination plays an important role in non-invasive and prompt screening examinations in detecting abdominal diseases. In this review, the author's experience of the usefulness and pitfalls of ultrasonographic examinations in children with gastrointestinal symptoms is presented. A total of 1,000 cases of children who underwent ultrasonographic evaluation in the Department of Pediatrics, Pusan National University Hospital were reviewed. The main causes leading to ultrasonographic evaluation were abdominal pain (43.9%), vomiting (17.3%), elevated liver enzymes (11.8%), and jaundice (9.8%). Abnormal ultrasonographic findings accounted for 57.9% of cases. The major abnormal findings were mesenteric lymphadenitis (29.2%), fatty liver (12.1%), hepatitis (6.4%), hepatosplenomegaly (6.2%), and acute appendicitis (4.8%). The major findings in children with abdominal pain were mesenteric lymphadenitis (32.6%), intussusception (2.7%), and acute appendicitis (2.7%). The major findings in children with vomiting were mesenteric lymphadenitis (12.7%), hypertrophic pyloric stenosis (10.4%), acute appendicitis (3.5%). The major ultrasonographic findings in children with urinary tract diseases were hydronephrosis (45.4%), urolithiasis (21.5%) and cystic renal disease (18.1%). Ultrasonography performed by pediatricians is advantageous because pediatricians are able to perform the procedure with clinical information at the right time.
Abdominal Pain ; Appendicitis ; Child ; Fatty Liver ; Hepatitis ; Humans ; Hydronephrosis ; Intussusception ; Jaundice ; Kidney Diseases, Cystic ; Liver ; Mass Screening ; Mesenteric Lymphadenitis ; Pediatrics ; Pyloric Stenosis, Hypertrophic ; Urolithiasis ; Urologic Diseases ; Vomiting

Organic diseases are prevalent in about 5 to 10% of children with chronic abdominal pain. The most common diseases of the upper digestive tract include gastroesophageal reflux disease (GERD), chronic gastritis with or without Helicobacter pylori (H. pylori), and peptic ulcer. The H. pylori infections acquired during childhood persist lifelong without eradication. Although the majority of H. pylori infected children remain asymptomatic, H. pylori infection may cause various digestive and extra-digestive diseases. There are still debates about a causal relationship between H. pylori-gastritis and abdominal symptoms in the absence of peptic ulcer disease. The number of Korean children infected with antibiotic resistant H. pylori is increasing even though the prevalence decreases after eradication. The choices of rescue therapy are limited in children after eradication failure. Antioxidant supplements with regimens against H. pylori have been tried with limited effects. Here I wanted to review the findings of recent reports on common upper digestive diseases such as GERD, peptic ulcer, and H. pylori infection in children with chronic abdominal pain.
Abdominal Pain ; Child ; Gastritis ; Gastroesophageal Reflux ; Gastrointestinal Tract ; Helicobacter pylori ; Humans ; Peptic Ulcer ; Prevalence

Functional abdominal pain (FAP) is one of the most common pain syndromes in childhood and is a functional gastrointestinal disorder (FGID). Recurrent abdominal pain (RAP) is characterized by three or more episodes of abdominal pain that occurover at least 3 months and are severe enough to interfere with activities. It may be caused by many conditions, including inflammatory bowel disease, peptic ulcer, pancreatitis or, functional abdominal pain. The most common clinical manifestation is periumbilical pain related to autonomic and functional symptoms like nausea, vomiting, pallor and other painful conditions like headache and limb pains. RAP requires accurate diagnostic tests to rule out organic causes of pain based on 'red flag' sign. Furthermore, to diagnose and classify functional abdominal pain, Rome III criteria were published and updated with multiple discussions of FGIDs. Conventional interventions for RAP include reassurance and general advice, symptom-based pharmacological therapies, and psychological and behavioral treatments. But further research should be conducted to advance our understanding of the multiple factors involved in the pathogenesis of this group of conditions and to provide evidence for its therapeutic benefit.
Abdominal Pain ; Child ; Diagnostic Tests, Routine ; Extremities ; Gastrointestinal Diseases ; Headache ; Humans ; Inflammatory Bowel Diseases ; Nausea ; Pallor ; Pancreatitis ; Peptic Ulcer ; Rome ; Vomiting

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