We demonstrated the clinical features and outcome of 87 children with idiopathic thrombocytopenic purpure (ITP). Most of them were younger children with severe thrombocytopenia; 71.3% were under 5 years old and 49.4% had platelet counts below 1×10⁴/μl. Initial treatment consisted of high-dose intravenous immunoglobulin in 60 (69.0%), steroid in 10 (11.5%), and no therapy in 17 (19.5%). More than 90% of the children with platelet counts below 2×10⁴/μl received treatment, but most children with platelet counts above 2×10⁴/μl were observed without treatment. No patients had complications with CNS hemorrhage. Chronic ITP was noted in 17 patients (19.5%). Their mean age was 6 years 3 months compared with 2 years 8 months for the acute patients (p<0.01). But there were no significant differences in sex, platelet count, and initial treatment between chronic ITP and acute ITP. Six (35.3%) out of 17 children with chronic ITP subsequently achieved a spontaneous recovery. As of today, only 3 patients (3% of all patients, and 17.6% of patients with chronic ITP) have platelet counts below 5×10⁴/μl. The overall prognosis and quality of life were excollent. Helicobacter Pylori (H. pylori) infection was found in 7.1% of the chronic patients and 5.3% of the acute patients, but platelet counts of them returned to normal without H. pylori eradication thrapy. It seemed that H. pylodi infection played a minor role in pediatric ITP.

We demonstrated the clinical features and outcome of 87 children with idiopathic thrombocytopenic purpure (ITP). Most of them were younger children with severe thrombocytopenia; 71.3% were under 5 years old and 49.4% had platelet counts below 1×104/μl. Initial treatment consisted of high-dose intravenous immunoglobulin in 60 (69.0%), steroid in 10 (11.5%), and no therapy in 17 (19.5%). More than 90% of the children with platelet counts below 2×104/μl received treatment, but most children with platelet counts above 2×104/μl were observed without treatment. No patients had complications with CNS hemorrhage. Chronic ITP was noted in 17 patients (19.5%). Their mean age was 6 years 3 months compared with 2 years 8 months for the acute patients (p<0.01). But there were no significant differences in sex, platelet count, and initial treatment between chronic ITP and acute ITP. Six (35.3%) out of 17 children with chronic ITP subsequently achieved a spontaneous recovery. As of today, only 3 patients (3% of all patients, and 17.6% of patients with chronic ITP) have platelet counts below 5×104/μl. The overall prognosis and quality of life were excollent. Helicobacter Pylori (H. pylori) infection was found in 7.1% of the chronic patients and 5.3% of the acute patients, but platelet counts of them returned to normal without H. pylori eradication thrapy. It seemed that H. pylodi infection played a minor role in pediatric ITP.
Purpura, Thrombocytopenic, Idiopathic ; Child ; Platelet Count ; seconds ; Chronic

Background/Aims: We aimed to investigate (1) promising clinical findings for the recognition of focal type autoimmune pancreatitis (FAIP) and (2) the impact of endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) on the diagnosis of FAIP. Methods: Twenty-three patients with FAIP were involved in this study, and 44 patients with resected pancreatic ductal adenocarcinoma (PDAC) were included in the control group. Results: (1) Multivariate analysis revealed that homogeneous delayed enhancement on contrast-enhanced computed tomography was a significant factor indicative of FAIP compared to PDAC (90% vs. 7%, p=0.015). (2) For 13 of 17 FAIP patients (76.5%) who underwent EUS-TA, EUS-TA aided the diagnostic confirmation of AIPs, and only one patient (5.9%) was found to have AIP after surgery. On the other hand, of the six patients who did not undergo EUS-TA, three (50.0%) underwent surgery for pancreatic lesions. Conclusions Homogeneous delayed enhancement on contrast-enhanced computed tomography was the most useful clinical factor for discriminating FAIPs from PDACs. EUS-TA is mandatory for diagnostic confirmation of FAIP lesions and can contribute to a reduction in the rate of unnecessary surgery for patients with FAIP.

Background/Aims: This study aimed to clarify the efficacy and safety of pancreatic duct lavage cytology combined with a cell-block method (PLC-CB) for possible pancreatic ductal adenocarcinomas (PDACs). Methods: This study included 41 patients with suspected PDACs who underwent PLC-CB mainly because they were unfit for undergoing endoscopic ultrasonography-guided fine needle aspiration. A 6-Fr double lumen catheter was mainly used to perform PLC-CB. Final diagnoses were obtained from the findings of resected specimens or clinical outcomes during surveillance after PLC-CB. Results: Histocytological evaluations using PLC-CB were performed in 87.8% (36/41) of the patients. For 31 of the 36 patients, final diagnoses (invasive PDAC, 12; pancreatic carcinoma in situ, 5; benignancy, 14) were made, and the remaining five patients were excluded due to lack of surveillance periods after PLC-CB. For 31 patients, the sensitivity, specificity, and accuracy of PLC-CB for detecting malignancy were 94.1%, 100%, and 96.8%, respectively. In addition, they were 87.5%, 100%, and 94.1%, respectively, in 17 patients without pancreatic masses detectable using endoscopic ultrasonography. Four patients developed postprocedural pancreatitis, which improved with conservative therapy. Conclusions PLC-CB has an excellent ability to detect malignancies in patients with possible PDACs, including pancreatic carcinoma in situ.

Purpose：This study investigated the factors associated with rehabilitation service satisfaction in convalescent stroke patients.Methods：This cross-sectional study included 41 participants (mean age 50.5 ± 9.3 years；73.2％ were male). Patients with severe cognitive impairment who were unable to respond to questionnaires were excluded from the study. At discharge, patient satisfaction was assessed using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS) tool. We also evaluated physical function using the Stroke Impairment Assessment Set-Motor (SIAS-M) gain tool, activities of daily living (ADL) using the Motor-Functional Independence Measure (M-FIM) effectiveness tool, depressive symptoms using the Japan Stroke Scale-Depression (JSS-D) tool, optimism using the revised Life Orientation Test (LOT-R), and service quality using the SERVPERF model. Stepwise regression analysis was performed to identify factors that were significantly associated with CSSNS scores.Results：The mean CSSNS score of participants was 55.5 ± 8.3 points. Stepwise multiple regression analysis showed that M-FIM effectiveness (β＝0.48, p＜0.01) and SERVPERF scores (β＝0.48, p＜0.01) were significantly associated with CSSNS scores.Conclusion：This study revealed that favorable improvements in ADL and better service quality were associated with higher rehabilitation service satisfaction in convalescent stroke patients.

Purpose：This study investigated the factors associated with rehabilitation service satisfaction in convalescent stroke patients.Methods：This cross-sectional study included 41 participants (mean age 50.5 ± 9.3 years；73.2％ were male). Patients with severe cognitive impairment who were unable to respond to questionnaires were excluded from the study. At discharge, patient satisfaction was assessed using the Customer Satisfaction Scale based on Need Satisfaction (CSSNS) tool. We also evaluated physical function using the Stroke Impairment Assessment Set-Motor (SIAS-M) gain tool, activities of daily living (ADL) using the Motor-Functional Independence Measure (M-FIM) effectiveness tool, depressive symptoms using the Japan Stroke Scale-Depression (JSS-D) tool, optimism using the revised Life Orientation Test (LOT-R), and service quality using the SERVPERF model. Stepwise regression analysis was performed to identify factors that were significantly associated with CSSNS scores.Results：The mean CSSNS score of participants was 55.5 ± 8.3 points. Stepwise multiple regression analysis showed that M-FIM effectiveness (β＝0.48, p＜0.01) and SERVPERF scores (β＝0.48, p＜0.01) were significantly associated with CSSNS scores.Conclusion：This study revealed that favorable improvements in ADL and better service quality were associated with higher rehabilitation service satisfaction in convalescent stroke patients.

Purpose：We investigated the factors associated with medical device-related pressure ulcer (MDRPU) due to lower extremity orthosis in patients undergoing convalescent rehabilitation for stroke.Methods：This retrospective study included patients with stroke who wore ankle foot orthosis in the convalescent rehabilitation ward. We measured the following items at admission：Brunnstrom recovery stage, presence of sensory disturbance, exhibition of unilateral spatial neglect, functional independence measures at admission and discharge, and presence of MDRPU. In the statistical analysis, logistic regression analysis was performed to identify the significant factors associated with MDRPU.Results：Ninety-five participants were enrolled in this study (mean age：54.9 ± 11.6 years, Male：78.9%). In logistic regression analysis, Age (odds ratio＝1.05, 95% confidence interval＝1.01-1.10, p＜0.05) and the presence of sensory disturbance (odds ratio＝5.17, 95% confidence interval＝1.39-19.28, p＜0.05) at admission was extracted as the cause of MDRPU.Conclusion：Sensory disturbance at admission is associated with MDRPU in patients undergoing convalescent rehabilitation for stroke who wear ankle foot orthosis.