Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occurs less commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, and nocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percent time of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Four years later, he presented with heartburn, solid-food dysphagia, daily post-prandial vomiting, and failure to thrive. Endoscopy showed a severely dilated esophagus with candidiasis. High-resolution manometry was performed, and he was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatation procedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolution manometry in children with atypical GERD even after evaluation with an impedance-pH monitor.
Candidiasis ; Child* ; Cough ; Deglutition Disorders ; Dilatation ; Electric Impedance ; Endoscopy ; Esophageal Achalasia* ; Esophageal pH Monitoring ; Esophagus ; Failure to Thrive ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Lost to Follow-Up ; Male ; Manometry* ; Vomiting

The prognosis of lateral medullary infarction is mostly benign, but unexpected sudden death can occur even when the initial symptoms are benign. An 81-year-old man visited the emergency room with whirling-type dizziness and right-veering tendency. Brain magnatic resonance imaging (MRI) revealed a right lateral medullary infarction accompanied by a right cerebellar infarction. He died suddenly at 1 day after admission with only slight lesion progression on MRI. This case suggests that patients with a lateral medullary infarction should be carefully monitored during the acute period.
Aged, 80 and over ; Brain ; Death, Sudden ; Dizziness ; Emergency Service, Hospital ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Medulla Oblongata ; Prognosis ; Stroke

PURPOSE: To evaluate the effects of hydrogen peroxide pretreatment and heat activation of silane on the shear bond strength of fiber-reinforced composite posts to resin cement. MATERIALS AND METHODS: The specimens were prepared to evaluate the bond strength of epoxy resin-based fiber posts (D.T. Light-Post) to dual-curing resin cement (RelyX U200). The specimens were divided into four groups (n=18) according to different surface treatments: group 1, no treatment; group 2, silanization; group 3, silanization after hydrogen peroxide etching; group 4, silanization with warm drying at 80℃ after hydrogen peroxide etching. After storage of the specimens in distilled water at 37℃ for 24 hours, the shear bond strength (in MPa) between the fiber post and resin cement was measured using a universal testing machine. The fractured surface of the fiber post was examined using scanning electron microscopy. Data were analyzed using one-way ANOVA and post-hoc analysis with Tukey's HSD test (α=0.05). RESULTS: Silanization of the fiber post (Group 2) significantly increased the bond strength in comparison with the non treated control (Group 1) (P<.05). Heat drying after silanization also significantly increased the bond strength (Group 3 and 4) (P<.05). However, no effect was determined for hydrogen peroxide etching before applying silane agent (Group 2 and 3) (P>.05). CONCLUSION: Fiber post silanization and subsequent heat treatment (80℃) with warm air blower can be beneficial in clinical post cementation. However, hydrogen peroxide etching prior to silanization was not effective in this study.
Cementation ; Hot Temperature* ; Hydrogen Peroxide* ; Hydrogen* ; Microscopy, Electron, Scanning ; Resin Cements* ; Shear Strength ; Water

We describe a 58-year-old woman who was incidentally found to have gastric and colonic polyposis, hypoalbuminemia, cutaneous hyperpigmentation and onychodystrophy (Cronkhite-Canada syndrome). Histology of polyps from the stomach showed features of juvenile or retention type (hamartomatous) polyps with Helicobacter pylori (H. pylori) infection. The large pedunculated colonic polyps showed hamartomatous polyps with adenomatous component and polypectomy was performed. After the treatment with H. pylori eradication and omeprazole, the gastric polyposis, hypoalbuminemia and anemia regressed, and endoscopic polypectomy of gastric polyps were performed. After the continuous use of omeprazole for 14 months, the patient showed complete resolution of clinical features of Cronkhite-Canada syndome. The experience of this case suggests that eradication of H. pylori and proton pump inhibitor treatment might be considered in patients with gastric polyposis combined with Cronkhite-Canada syndome.
Anti-Ulcer Agents/*therapeutic use ; Colonic Polyps/complications/microbiology/pathology ; Female ; Helicobacter Infections/complications/*drug therapy ; *Helicobacter pylori ; Humans ; Hyperpigmentation/pathology ; Middle Aged ; Nails, Malformed/pathology ; Omeprazole/*therapeutic use ; Polyps/*complications/microbiology/pathology ; Proton Pumps/antagonists & inhibitors ; Stomach Neoplasms/*complications/microbiology/pathology ; Syndrome

Eosinophilic gastroenteritis is a rare disease characterized by prominent eosinophilic tissue infiltration of the gastrointestinal tract. Here, we report a case of eosinophilic gastroenteritis in an 18-year-old patient with prolonged nephrotic syndrome who presented with abdominal pain and peripheral hypereosinophilia. During the previous 2 years, he had visited local Emergency Department several times because of epigastric pain and nausea. He had been treated with steroid-dependent nephrotic syndrome since 3 years of age. Tests ruled out allergic and parasitic disease etiologies. Gastroduodenoscopy with biopsy revealed marked eosinophilic infiltration in the duodenum. Renal biopsy findings indicated minimal change disease spectrum without eosinophilic infiltration. The oral deflazacort dosage was increased, and the patient was discharged after abdominal pain resolved. To our knowledge, this is the first report of eosinophilic gastroenteritis in a patient with minimal change disease.
Abdominal Pain ; Adolescent* ; Biopsy ; Duodenum ; Emergency Service, Hospital ; Eosinophilia ; Eosinophils* ; Gastroenteritis* ; Gastrointestinal Tract ; Humans ; Male* ; Nausea ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Parasitic Diseases ; Rare Diseases

Inflammatory bowel disease has a potential risk of developing colorectal cancer. However, there is little causal relationship between intestinal tuberculosis and colon cancer because intestinal tuberculosis is curable disease and has relatively short disease course. But there were a few case reports of intestinal tuberculosis associated with colon cancer. Diffuse infiltrating colon cancer, characterized by tumor cells in the presence of inflammatory changes with much fibrosis, is very rare in the colon. We experienced a 49-year-old woman who had tuberculous colitis combined with diffuse infiltrative colon cancer. She visited our hospital because of chronic diarrhea and abdominal pain. Colonoscopy showed multiple geographic ulcers in the transverse colon and partial intestinal obstruction. Histological examination revealed non-caseating granuloma and Mycobacterium tuberculosis was cultured in biopsied tissue. She took an anti-tuberculosis drug for 2 weeks, but her symptoms were aggravated. Therefore, extended right hemicolectomy was performed and revealed mucin-secreting, diffuse infiltrating adenocarcinoma. Herein, we report a rare case of diffuse infiltrative colon cancer coexisting with colonic tuberculosis with a review of liferatures.
Abdominal Pain ; Adenocarcinoma ; Colitis ; Colon* ; Colon, Transverse ; Colonic Neoplasms* ; Colonoscopy ; Colorectal Neoplasms ; Diarrhea ; Female ; Fibrosis ; Granuloma ; Humans ; Inflammatory Bowel Diseases ; Intestinal Obstruction ; Middle Aged ; Mycobacterium tuberculosis ; Tuberculosis* ; Ulcer

PURPOSE: Gastro-esophageal reflux (GER), particularly non-acid reflux, is common in infants and is a known cause of chronic respiratory symptoms in infancy. Recent guidelines recommended empirical acid suppression therapy and the head-up position in patients with suspected GER. However, the efficacy of the upright position in relieving GER and reflux-related respiratory symptoms in infants is unclear. We conducted this study to investigate the efficacy of the upright position on GER and reflux-related respiratory symptoms in infants with chronic respiratory symptoms. METHODS: Thirty-two infants (21 male; median age, 5 months; range, 0 to 19 months) with unexplained chronic respiratory symptoms underwent multi-channel intraluminal esophageal impedance and pH monitoring. We retrospectively compared the frequencies of GER and reflux-related symptoms according to body position. RESULTS: A mean of 3.30 episodes of reflux per hour was detected. Overall, refluxes were more frequent during the postprandial period than the emptying period (3.77 vs. 2.79 episodes/hour, respectively; P=0.01). Although there was no significant difference in the total refluxes per hour between the upright and recumbent positions (6.12 vs. 3.77 episodes, P=0.10), reflux-related respiratory symptoms per reflux were significantly fewer in infants kept in an upright position than in a recumbent position during the postprandial period (3.07% vs. 14.75%, P=0.016). Non-acid reflux was the predominant type of reflux in infants, regardless of body position or meal time. CONCLUSIONS: The upright position may reduce reflux-related respiratory symptoms, rather than reflux frequency. Thus, it may be a useful non-pharmacological treatment for infantile GER disease resistant to acid suppressants.
Electric Impedance ; Esophageal pH Monitoring ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Infant ; Meals ; Postprandial Period ; Retrospective Studies

In this article (J Korean Med Sci 2015; 30: 644-50), one author's name is misspelled. Correct Sung-Hun Im into Seong Hoon Lim.

Histamine H2-receptor antagonists are commonly used in many clinical conditions, and their hepatotoxicity has been reported occasionally.However, cholestatic hepatitis induced by nizatidine is very rare. Here, we report a young female patient with severe cholestatic hepatitis associated with nizatidine use. She had taken nizatidine to manage asymptomatic reflux laryngitis by an otonasolaryngology doctorfor about 20 days. After about 15 days of nizatidine administration, jaundice developed and continued for more than2 months withmaximal serum total bilirubin reaching 17.5 mg/dL, in spite of the discontinuation of medication. Liver specimen obtained by needle biopsy revealed severe centrilobular cholestatic hepatitis. Her liver function improved slowly and serum total bilirubin decreased down to 1.7 mg/dL after months later from the development of jaundice. As far as our knowledge, this is the second case of nizatidine- induced cholestatic hepatitis reported in the literature.
Bilirubin ; Biopsy, Needle ; Cholestasis ; Female ; Hepatitis* ; Histamine ; Humans ; Jaundice ; Laryngitis ; Liver ; Nizatidine*

The superior vena cava (SVC) syndrome results from the disturbance of blood flow in superior vena cava caused by the obstruction. The most common etiology of this condition is the external compression by a malignant tumor. Other causes include thrombus from a pacemaker, defibrillator or central venous catheters. The conventional treatment is radiation and chemotherapy. Recently stenting has been used as a first-line therapeutic strategy for non-malignant cases with balloon and self-expanding stents. In our report, a 77 year-old woman had the SVC syndrome without identification of an underlying disease. A percutaneous endovascular intervention was performed. The stent was placed successfully but just after the procedure, the venous return immediately increased and acute pulmonary edema developed. The patient improved after intravenous diuretics and oxygen. Here we report our experience and review the medical literatures for the management of the non-malignant SVC syndrome, with percutaneous endovascular intervention and the rare complication of pulmonary edema.
Central Venous Catheters ; Defibrillators ; Diuretics ; Female ; Humans ; Oxygen ; Pulmonary Edema ; Stents ; Thrombosis ; Vena Cava, Superior