PURPOSE: In order to clarify the role of Helicobacter pylori(H. pylori) in recurrent abdominal pain, we investigated prospectively the effect of eradication of H. pylori based on symptom improvement in children with recurrent abdominal pain. METHODS: Children with recurrent abdominal pain were evaluated with diagnostic upper gastrointestinal endoscopy to rule out peptic ulcer disease, etc. During endoscopy, biopsies were taken and sent for CLO test and histologic evaluation with H-E stain and Alcian-Yellow stain. Twenty four out of 28 H. pylori infected children didn't have peptic ulcer disease. They underwent triple therapy with bismuth subcitrate, amoxicillin and clarithromycin. Four weeks after the end of the therapy, patients were evaluated with regard to their symptoms. RESULTS: In patients with H. pylori eradication, the mean total symptom score decreased significantly at four weeks' follow-up after the treatment(9.1+/-3.6 vs. 1.4+/-1.5; P<0.001). The frequency of abdominal pain per week also decreased significantly from 26.0+/-21.1 times/week to 1.4+/-1.5 times/ week after eradication of H. pylori(P<0.001). Age, duration of symptom and endoscopic findings did not prove to be positive predictive factors of significant improvement of symptoms after H. pylori eradication. CONCLUSION: We strongly recommend looking for H. pylori infection in children complaining of recurrent abdominal pain. Eradication of this organism will effectively and significantly reduce the extent of symptoms associated with recurrent abdominal pain.
Abdominal Pain* ; Amoxicillin ; Biopsy ; Bismuth ; Child* ; Clarithromycin ; Endoscopy ; Endoscopy, Gastrointestinal ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Peptic Ulcer ; Prospective Studies ; Upper Gastrointestinal Tract

Mitomycin C (MMC) trabeculectomy combined with extracapsular cataract extraction and posteor chamber intraocular lens implantation (glaucoma triple procedure, 30 eyes) was clinically compared with MMC trabeculectomy alone (30 eyes). The age, type of glaucoma, and preoperative number of medications were matched with the previous group (P>0.05). The mean preoperative intraocular pressures (IOPs) were 30.2+/-8.3mmHg (range, 22~56mmHg) in the glaucoma triple procedure group and 31.6+/-8.9mmHg (range, 22~57mmHg) in the trabeculectomy alone group (p=0.55). The mean postoperative IOPs were significantly higher in the glaucoma triple procedure group compared with the trabeculectomy alone group at all postoperative vistis (one month to nine months) (p<0.05). However, there were no statistically significant differences in the mean number of postoperative rise exceeding 30 mmHg within the postoperative one month tended to occur more frequently in the glaucoma triple procedure group (7 eyes (23%)) than the trabeculectomy alone group (2 eyes(7%)) (p=0.13). Conjunctival filtering blebs were significantly frequently observed in the trabeculectomy alone group than the glaucoma triple procedure group (28 eyes (93%), 20 eyes (67%), respectively, P=0.02) at 6 months postoperatively. The common postoperative complications were hyphema (4 eyes) and posterior capsular opacification (4 eyes) in the glaucoma triple procedure group and shallow anterior chamber(4 statistical difference was noted between these two groups (p>0.05). Although hypotensive effect of MMC on the glaucoma triple procedure was less than on the trabeculectomy alone, glaucoma triple procedure using MMC could be recommended to be safe and effective on controlling the high IOP for treating glaucoma patients with coexisting cataract.
Blister ; Cataract ; Cataract Extraction ; Glaucoma* ; Humans ; Hyphema ; Intraocular Pressure ; Lens Implantation, Intraocular ; Mitomycin* ; Postoperative Complications ; Trabeculectomy*

The use of mitomycin C as an adjunct improves the success rate of filtering surgery. Blebs after trabeculectomy with mitomycin C tend to be relatively transparent, thin-walled and cystic. Such a bleb is associated with low intraocular pressure but tends to leak and may predispose an eye to endophthalmitis. However, the incidence and risk factors associated with this complication are not known. To determine the incidence and possible risk factors for the development of thin-walled blebs, case records of 160 eyes of 112 patients who received mitomycin C during trabeculectomy were reviewed. Thin-walled, cystic blebs developed postoperatively in 38 (23.8%) of 160 eyes that underwent trabeculectomy with mitomycin C between 1992 and 1995. As the postoperative follow-up time became longer, a greater development of thinwalled cystic blebs was noted. Characteristics of patients after trabeculectomy with mitomycin C in whom thin-walled blebs developed were compared with those of patients in whom thin-walled blebs did not develop. Factors associated with increased risk were: thin conjunctiva and Tenon's capsule (odds ratio 12.7, 95% confidence interval 2.2 to 73.4, P=0.002), uncomplicated glaucoma (primary open-angle glaucoma >or=50 years, primary angle-closure glaucoma) (odds ratio 3.3, 95% confidence interval 1.5 to 7.0, P=0.002), and systemic hypertension (odds ratio 3.8, 95% confidence interval 1.7 to 8.6, P=0.001).
Blister* ; Conjunctiva ; Endophthalmitis ; Filtering Surgery ; Follow-Up Studies ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Hypertension ; Incidence ; Intraocular Pressure ; Mitomycin* ; Risk Factors* ; Tenon Capsule ; Trabeculectomy*

Attempts to quantify the parameters of optic nerve head structure have been made to recognize the earliest structural abnormalities in glaucoma, and to efficiently monitor the structural changes of the optic nerve head with advancing disease. Optic disc parameters were measured in 88 normal subjects and 149 primary open-angle glaucoma patients using a computer graphic program (Adobe photoshopTM) and the photographic magnification was corrected according to Littmanns method. The sensitivity, specificity, and predictive value of optic disc parameters were calculated to discriminate between normal and glaucomatous eyes at different stages of glaucoma. Receiver operating characteristics curves were used for comparisons of different disc parameters. In the group with mild glaucomatous visual field (VF) defects (mean deviation (MD); better than -5dB, group 1), optic disc parameters did not provide greater sensitivity and specificity enough to detect early glaucomatous optic nerve head damage. In the group with moderate VF defects (MD; -6~-10dB, group 2) and advanced VF defects (MD; worse than -11dB, group 3), the minimum rim width within the 60 sector across the vertical meridian (predictive value; 84.4%, 95.9%, respectively), vertical cup to disc ratio (83.7%, 95.2%, respectively), and rim area to disc area ratio (83.7%, 95.1%, respectively) were helpful to identify the glaucomatous eyes, whereas horizontal cup to disc ratio (77.3%, 90.3%, respectively) and cup area (75.2%, 89.0%, respectively) were less helpful in this regard.
Computer Graphics ; Glaucoma ; Glaucoma, Open-Angle* ; Humans ; Optic Disk ; ROC Curve ; Sensitivity and Specificity* ; Visual Fields

Anisakiasis is a accidental parasitic infection caused by nematode larvae belonging to the subfamily Anisakinae when a raw or inadequately cooked fish is ingested. The common clinical symptoms are severe colicky abdominal pain or epigastric full sensation, nausea, vomiting and fever, but hematemesis or melena is very rare. We report a case of a 11-year-old female child who developed severe epigastric pain recurrently for 2 months, and recalled that she had eaten the raw flesh of an Astroconger myriaster. Endoscopic examination showed the whitish worm invading the stomach wall. Clinical symptoms disappeared after endoscopic removal. This study may be the first pediatric case of gastric anisakiasis in korea.
Abdominal Pain* ; Anisakiasis* ; Child* ; Female ; Fever ; Hematemesis ; Humans ; Korea ; Larva ; Melena ; Nausea ; Sensation ; Stomach ; Vomiting

PURPOSE: To compare the glaucomatous optic nerve damage in primary angle-closure glaucoma (PACG) with acute attack (acute PACG; AACG) and PACG without acute attack (chronic PACG; CACG). METHODS: The study subjects were 84 normal individuals, 130 AACG patients, and 86 CACG patients. Color optic disc photographs were evaluated for the presence or absence of 10 qualitative signs to differentiate between normal and glaucomatous optic discs. RESULTS: Abnormally shaped rim width (alteration of ISN'T rule), bared circumlinear vessel, vessel bayonetting, rim width narrower than the temporal sector, and zone beta (nasal and superotemporal sectors) were detected more frequently in the CACG group than in the AACG group (P< 0.05). The most accurate qualitative sign was abnormally shaped rim width in both groups. The specificity and sensitivity of abnormally shaped rim width were 71.4% and 60.8% for AACG, and 71.4% and 81.4% for CACG, respectively. CONCLUSIONS: The optic disc damage is greater in CACG than in AACG.
Optic Nerve/*pathology ; Middle Aged ; Male ; Intraocular Pressure ; Humans ; Glaucoma, Angle-Closure/*pathology/physiopathology ; Female ; Chronic Disease ; Aged ; Acute Disease

PURPOSE: Magnetic resonance cholangiopancreatography(MRCP) is a noninvasive method for imaging the pancreaticobiliary tree. The aim of this study was to evalute the usefulness of MRCP for the diagnosis of pancreaticobiliary diseases in children. METHODS: From October 1996 to May 2001, 67 patients with obstructive jaundice and three patients with chronic recurrent pancreatitis were evaluated with abdominal ultrasonography and MRCP. The final diagnosis was based on the operative and pathologic findings with biopsy specimen including clinical and laboratory findings. RESULTS: A total of 70 patients, consisting of 31 males and 39 females, with a mean age of 2.6+/-3.3 years were studied. The final diagnosis was biliary atresia in 25, neonatal cholestasis in 18, choledochal cyst without anomalous pancreatobiliary duct union(APBDU) in nine, choledochal cyst with APBDU in seven, cholestatic hepatitis in five, chronic recurrent pancreatitis in three, sclerosing cholangitis in two, and secondary biliary cirrhosis in one case. The overall diagnostic accuracy of abdominal ultrasonography was 75.7% and that of MRCP was 97.1%. The sensitivity and specificity of MRCP were 100% and 98% for biliary atresia, 87.5% and 100% for choledochal cyst with APBDU, 100% and 100% for choledochal cyst without APBDU, sclerosing cholangitis and chronic recurrent pancreatitis, respectively. CONCLUSION: MRCP is a fast, non-invasive and reliable method for diagnosing pancreaticobiliary diseases in children and will be the standard diagnostic procedure in the future.
Biliary Atresia ; Biopsy ; Child* ; Cholangitis, Sclerosing ; Choledochal Cyst ; Cholestasis ; Diagnosis ; Female ; Hepatitis ; Humans ; Jaundice, Obstructive ; Liver Cirrhosis, Biliary ; Male ; Pancreatitis ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: To evaluate the effect of a single intravitreal injection of 4.0 mg/0.1ml triamcinolone acetonide on intraocular pressure (IOP). METHODS: Retrospective studies were conducted by reviewing the charts of 26 eyes of 24 patients that were followed up for 16 weeks after intravitreal triamcinolone injection. The IOPs before and after triamcinolone injection were measured with Goldmann applanation tonometer. RESULTS: Within 16 weeks after intravitreal triamcinolone acetonide injection, 23 of 26 eyes (88.5%) demonstrated an increment in IOP of 5 mmHg or greater, and 6 of 26 (23.1%) had an increment of 10 mmHg or greater. The mean duration of the increase in IOP of 5 mmHg or greater was 5.5 weeks (standard deviation=4.4), and the mean time to reach maximum IOP was 6.6 weeks (standard deviation=4.4). The difference between the mean pre-injection IOP (14.12 mmHg, n=26) and the maximum post-injection IOP (24.65 mmHg, n=26) was statistically significant (P<0.001). All eyes that needed treatment responded to topical glaucoma medication. CONCLUSIONS: An increment in IOP is a common complication after a single intravitreal injection of 4.0 mg/0.1ml triamcinolone acetonide and despite this serious increment in IOP, it was controlled by topical glaucoma medication.
Glaucoma ; Humans ; Intraocular Pressure* ; Intravitreal Injections ; Retrospective Studies ; Triamcinolone Acetonide* ; Triamcinolone*

PURPOSE: Blowout fracture is an outward fracture of the orbital wall. That usually occurs at inferior or medial wall of the orbit. The main pathophysiology is high intraocular pressure derived from impact of trauma. Among the four orbital wall, the medial wall is thinnest and most vulnerable to trauma. Many kinds of methods were introduced for correction of medial orbital wall fracture. Recently, transnasal endoscopic reconstruction methods were widely used. Endoscopic methods had many advantages. However, we experienced some cases of postoperative maxillary sinusitis. This study was planned to find out the effectiveness of middle meatal antrostomy after endoscopic reconstruction of medial orbital wall fracture. METHODS: This study was retrospective analysis of 28 patients who underwent transnasal endoscopic repair of medial orbital wall fracture. The 18 male and 10 female patients were ranged from 17 to 57 years of age(mean, 30.9 years). Among 28 patients, randomly selected 17 patients underwent middle meatal antrostomy as additional procedure by the same surgeon. After at least 12 months of follow-up period, we examined the nasal symptom, endoscopic and CT findings. RESULTS: One patient complained of nasal obstruction in middle meatal antrostomy group and four patients complained nasal symptoms in non middle meatal antrostomy group. On the endoscopic findings, three patients of non middle meatal antrostomy group had continuous nasal discharge. But middle meatal antrostomy group had no abnormal endoscopic findings. The abnormal CT finding(abnormal mucosal hypertrophy) were detected in four patient of non middle meatal antrostomy group. There were no abnormal CT findings in middle meatal antrostomy group. The data were statistically significant at comparative study. CONCLUSION: Authors think that the middle meatal antrostomy has some advantages as a additional procedure of endoscopic reconstruction of medial orbital wall fracture. Especially, it is good at preventing post- operative maxillary sinusitis. But, more larger group and strict application of disease entity are need for correct evaluation of middle meatal antrostomy effect.
Female ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Nasal Obstruction ; Orbit* ; Orbital Fractures* ; Retrospective Studies

To identify the pattern of glaucomatous changes of the optic disc, the rim area to disc area ratio (RA/DA ratio) of 149 eyes (149 cases) with primary open-angle glaucoma (POAG) were measured and compared with that of 88 eyes (88 cases) of normal individuals. At all stages of the disease, glaucomatous rim loss was present in all sectors of the optic disc. The location of the most pronounced rim loss changed depending on the severity of the disease. In the early (RA/DA ratio > 61%; mean deviation(MD): -6.43+/-3.32dB) and medium (RA/DA ratio=41~60%; MD: -7.54+/-5.65dB) glaucoma subgroups, rim loss was found predominantly at the inferior temporal and superior temporal disc region. In the advanced glaucoma subgroup (RA/DA ratio=40~21%; MD: -18.27+/-8.40dB), the temporal horizontal disc region showed relatively marked rim loss. In the far advanced glaucoma subgroup (RA/DA ratio=20~0%; MD: -25.91+/-5.40dB), the rim remnants were located mainly in the nasal disc sector, with a larger rim portion in the upper nasal region than in the lower nasal region. These results indicate that generally in POAG, the loss of neuroretinal rim was found to start predominantly in the inferior temporal and superior temporal disc region, and then the temporal horizontal, the inferior nasal, and the superior nasal disc sectors followed.
Glaucoma ; Glaucoma, Open-Angle* ; Optic Disk