We performed surgery for correction of abnormal head turn in 10 patients with congenital nystagmus. For 3 patients with a head turn of 30 degrees, a 40% augmented modified kestenbaum operation was performed. For 4 patients with a head turn of 45 degrees, a 40% augmented modified kestenbaum operation combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. Finally, for 3 patients with a head turn of 60 degrees, a 60% augmented modified kestenbaum procedure combined with a 3 - 4 mm recession of conjunctival and subconjunctival tissues was performed. At the final follow-up visit(averaging 5.9 months), 7 patients showed complete corrections of previous head turn and 3 patients showed a small residual head turn of less than 10 degrees to the same side of the preoperative head turn. The average amount of correction we obtained from the surgery described above were 26.7, 42.5 and 56.7 degrees for the patients who had had a preoperative head turn of 30, 45 and 60 degrees respectively. Among the 10 patients, 4 showed no change in corrected visual acuity, but 6 showed increased corrected visual acuity by over 1 Snellen line. From the above results, we concluded that if recession procedure of the conjunctival and subconjunctival tissues was combined with augmented modified Kestenbaum procedure, its effect for correction of abnormal head turn in a patient with congenital nystagmus could be enhanced.
Follow-Up Studies ; Head* ; Humans ; Nystagmus, Congenital* ; Visual Acuity

Established antiepileptic drugs (AEDs) decrease membrane excitability by interacting with neurotransmitter receptors or ion channels. AEDs developed prior to 1980 appear to act on sodium channels, gamma-amino butyric acid type A (GABA(A)) receptors or calcium channels. Benzodiazepines and barbiturates enhance GABA(A) receptormediated inhibition. Barbiturates increase the duration of chloride channel opening and at higher doses, they block voltage-dependent calcium channels presynaptically, decreasing excitatory amino acid (EAAs) transmission. Benzodiazepines also interact with the GABA(A) receptor complex and increase the frequency of chloride channel opening. Phenytoin, carbamazepine and possibly sodium valproate decrease high frequency repetitive firing of action potentials by enhancing sodium channel inactivation. At higher doses, PHT may block sodium channels presynaptically and decrease EAAs release. In addition to the action on sodium channel, CBZ interacts with adenosine receptor and decrease C-AMP, and block reuptake of norepinephrine. VPA shows diverse mechanisms including sodium channel blocking. It increases synaptosomal GABA by increasing production and decreasing break-down and interacts with T-type calcium channels preventing thalamocortical interaction necessary for absence. Ethosuximide and sodium valproate reduce a low threshold (T-type) calcium channel current. The mechanisms of action of newly developed AEDs are not fully established. Felbamate is broad-spectrum, and probably has multiple actions on sodium channels, interaction with GABA(A) receptors, and interaction with NM.D.A receptors. Gabapentin binds to a high affinity site on neuronal membranes in a restricted regional distribution of the CNS. This binding site may be related to a possible active transport process of gabapentin into neurons. However this has not proven and the mechanism of action of gabapentin remains uncertain. It is structurally related to GABA and its action of antiepileptic activity is suspected due to change of neuronal amino acids (interfere glutamate synthesis, block GABA uptake, and enhance GABA release). Lamotrigine, initially developed as an antifolate drug, decreases sustained high frequency repetitive firing of voltage-dependent sodium action potentials that may result in a preferential decreased release of presynaptic glutamate. It may also interact with GABA receptors but its primary antiepileptic action is on the sodium channel similar to the PHT and CBZ. Because of such a diverse mechanism of action, LTG is one of the wide spectrum AEDs. Oxcarbazepine's mechanism of action is not known ; however, its similarity in structure and clinical efficacy to that of carbamazepine suggests that its mechanism of action may involve inhibition of sustained high frequency repetitive firing of voltage-dependent sodium action potentials. Vigabatrin is a "designer" drug as is developed rationally, and it reversibly inhibits GABA transaminase, the enzyme that degrades GABA, thereby producing greater available pools of presynaptic GABA for release in central synapses. Increased activity of GABA at postsynaptic receptors may underlie the clinical efficacy of VGB. Tiagabine is a potent blocker of GABA re-uptake by glia and neuron.
4-Aminobutyrate Transaminase ; Action Potentials ; Amino Acids ; Anticonvulsants* ; Barbiturates ; Benzodiazepines ; Binding Sites ; Biological Transport, Active ; Butyric Acid ; Calcium Channels ; Calcium Channels, T-Type ; Carbamazepine ; Chloride Channels ; Ethosuximide ; Excitatory Amino Acids ; Fires ; gamma-Aminobutyric Acid ; Glutamic Acid ; Ion Channels ; Membranes ; Neuroglia ; Neurons ; Neurotransmitter Agents ; Norepinephrine ; Phenytoin ; Receptors, GABA ; Receptors, GABA-A ; Receptors, Neurotransmitter ; Receptors, Purinergic P1 ; Sodium ; Sodium Channels ; Synapses ; Valproic Acid ; Vigabatrin

Purpose: Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and metabolic syndrome. This study evaluated the significance of markers such as the triglyceride-to-highdensity lipoprotein cholesterol (TG/HDL-C) ratio and TG-glucose (TyG) indices in a group of patients with NAFLD. Methods: We retrospectively analyzed the data of patients aged 5–18 years diagnosed with NAFLD between January 2014 and January 2021. Results: Among the 151 patients with NAFLD, 79.5% were found to be obese, and the mean TG/HDL-C ratio (3.78±2.54 vs. 3.13±2.24) and TyG index (4.69±0.28 vs. 4.56±0.30) were slightly higher in patients with obesity compared to those without obesity. Patients with severe hepatic steatosis had a significantly higher mean TG/HDL-C ratio (4.11±2.16 vs. 3.11±2.30, p=0.035) than those with mild to moderate steatosis. Severe hepatic steatosis grade was defined as an area under the receiver operating characteristic curve of the TG/HDL-C ratio of 0.760 (95% confidence interval, 0.544–0.875), with an optimal cutoff value of 3.37. Conclusion A high TG/HDL-C ratio is associated with severe hepatic steatosis and diabetes mellitus in children with NAFLD. Measurement of this ratio can help clinicians in identifying patients and targeting them for treatment and follow-up.

Prolonged disorders of consciousness comprise a spectrum of impaired consciousness where arousal is preserved with impaired awareness, which last more than 4 weeks. Vegetative state is a prototype of the prolonged disorders of consciousness. A patient in the vegetative state has no signs of awareness. The minimally conscious state is characterized by inconsistent but reproducible signs of awareness and is regarded as a transitional state of recovery of consciousness. Differentiating patients in minimally conscious state from those in vegetative state is still challenging. Utilizing standardized neurobehavioral assessment tools could improve diagnostic accuracy. Recent advances in neuroimaging and electrophysiologic tools may aid the diagnosis and prognostication. Treatment for recovery of consciousness is still limited. More research on the diagnosis and treatment of prolonged disorders of consciousness is needed not only for improved care of patients with prolonged disorders of consciousness but also a greater understanding of human consciousness.

Purpose: Helicobacter pylori is a Gram-negative bacterium that is associated with peptic ulcer disease (PUD) and gastric cancer. However, studies on the endoscopic finding and factors related to H. Pylori infection in children are lacking. This study aimed to evaluate the prevalence and factors associated with H. Pylori infection in children with dyspepsia. Methods: We retrospectively analyzed the medical records of patients aged <18 years who underwent upper endoscopy for dyspepsia between January 2015 and December 2022.H. Pylori was diagnosed using a rapid urease test, and the dyspeptic symptoms included postprandial fullness, early satiation, epigastric pain, and nausea. Results: Among 185 patients, the prevalence of H. Pylori infection was 16.2%. Obesity and a family history of H. Pylori infection were more frequently observed in patients with H.pylori infection than in those without. Anemia was also more common in patients with H.pylori infection than in those without. H. Pylori was detected in six (18.8%) patients with PUD (n=32). All six patients had duodenal ulcers and anemia, and complications such as obstruction and bleeding were significantly more common among patients with PUD who were positive for H. Pylori infection than among those without. Conclusion We observed a low prevalence of H. Pylori infection in children with dyspepsia;however, these children exhibited a more severe clinical course. Therefore, caution should be exercised in detecting H. Pylori infection in children, especially, who had obesity or family history of H. Pylori infection.

Purpose: Helicobacter pylori is a Gram-negative bacterium that is associated with peptic ulcer disease (PUD) and gastric cancer. However, studies on the endoscopic finding and factors related to H. Pylori infection in children are lacking. This study aimed to evaluate the prevalence and factors associated with H. Pylori infection in children with dyspepsia. Methods: We retrospectively analyzed the medical records of patients aged <18 years who underwent upper endoscopy for dyspepsia between January 2015 and December 2022.H. Pylori was diagnosed using a rapid urease test, and the dyspeptic symptoms included postprandial fullness, early satiation, epigastric pain, and nausea. Results: Among 185 patients, the prevalence of H. Pylori infection was 16.2%. Obesity and a family history of H. Pylori infection were more frequently observed in patients with H.pylori infection than in those without. Anemia was also more common in patients with H.pylori infection than in those without. H. Pylori was detected in six (18.8%) patients with PUD (n=32). All six patients had duodenal ulcers and anemia, and complications such as obstruction and bleeding were significantly more common among patients with PUD who were positive for H. Pylori infection than among those without. Conclusion We observed a low prevalence of H. Pylori infection in children with dyspepsia;however, these children exhibited a more severe clinical course. Therefore, caution should be exercised in detecting H. Pylori infection in children, especially, who had obesity or family history of H. Pylori infection.

Purpose: Helicobacter pylori is a Gram-negative bacterium that is associated with peptic ulcer disease (PUD) and gastric cancer. However, studies on the endoscopic finding and factors related to H. Pylori infection in children are lacking. This study aimed to evaluate the prevalence and factors associated with H. Pylori infection in children with dyspepsia. Methods: We retrospectively analyzed the medical records of patients aged <18 years who underwent upper endoscopy for dyspepsia between January 2015 and December 2022.H. Pylori was diagnosed using a rapid urease test, and the dyspeptic symptoms included postprandial fullness, early satiation, epigastric pain, and nausea. Results: Among 185 patients, the prevalence of H. Pylori infection was 16.2%. Obesity and a family history of H. Pylori infection were more frequently observed in patients with H.pylori infection than in those without. Anemia was also more common in patients with H.pylori infection than in those without. H. Pylori was detected in six (18.8%) patients with PUD (n=32). All six patients had duodenal ulcers and anemia, and complications such as obstruction and bleeding were significantly more common among patients with PUD who were positive for H. Pylori infection than among those without. Conclusion We observed a low prevalence of H. Pylori infection in children with dyspepsia;however, these children exhibited a more severe clinical course. Therefore, caution should be exercised in detecting H. Pylori infection in children, especially, who had obesity or family history of H. Pylori infection.

Purpose: Helicobacter pylori is a Gram-negative bacterium that is associated with peptic ulcer disease (PUD) and gastric cancer. However, studies on the endoscopic finding and factors related to H. Pylori infection in children are lacking. This study aimed to evaluate the prevalence and factors associated with H. Pylori infection in children with dyspepsia. Methods: We retrospectively analyzed the medical records of patients aged <18 years who underwent upper endoscopy for dyspepsia between January 2015 and December 2022.H. Pylori was diagnosed using a rapid urease test, and the dyspeptic symptoms included postprandial fullness, early satiation, epigastric pain, and nausea. Results: Among 185 patients, the prevalence of H. Pylori infection was 16.2%. Obesity and a family history of H. Pylori infection were more frequently observed in patients with H.pylori infection than in those without. Anemia was also more common in patients with H.pylori infection than in those without. H. Pylori was detected in six (18.8%) patients with PUD (n=32). All six patients had duodenal ulcers and anemia, and complications such as obstruction and bleeding were significantly more common among patients with PUD who were positive for H. Pylori infection than among those without. Conclusion We observed a low prevalence of H. Pylori infection in children with dyspepsia;however, these children exhibited a more severe clinical course. Therefore, caution should be exercised in detecting H. Pylori infection in children, especially, who had obesity or family history of H. Pylori infection.

Purpose: Helicobacter pylori is a Gram-negative bacterium that is associated with peptic ulcer disease (PUD) and gastric cancer. However, studies on the endoscopic finding and factors related to H. Pylori infection in children are lacking. This study aimed to evaluate the prevalence and factors associated with H. Pylori infection in children with dyspepsia. Methods: We retrospectively analyzed the medical records of patients aged <18 years who underwent upper endoscopy for dyspepsia between January 2015 and December 2022.H. Pylori was diagnosed using a rapid urease test, and the dyspeptic symptoms included postprandial fullness, early satiation, epigastric pain, and nausea. Results: Among 185 patients, the prevalence of H. Pylori infection was 16.2%. Obesity and a family history of H. Pylori infection were more frequently observed in patients with H.pylori infection than in those without. Anemia was also more common in patients with H.pylori infection than in those without. H. Pylori was detected in six (18.8%) patients with PUD (n=32). All six patients had duodenal ulcers and anemia, and complications such as obstruction and bleeding were significantly more common among patients with PUD who were positive for H. Pylori infection than among those without. Conclusion We observed a low prevalence of H. Pylori infection in children with dyspepsia;however, these children exhibited a more severe clinical course. Therefore, caution should be exercised in detecting H. Pylori infection in children, especially, who had obesity or family history of H. Pylori infection.