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

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*

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

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*

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

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*

BACKGROUND: Fracture-dislocation of the proximal interphalangeal (PIP) joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair. METHODS: We treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate. RESULTS: At a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications. CONCLUSIONS: This technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.
Aluminum ; Finger Joint ; Follow-Up Studies ; Humans ; Intra-Articular Fractures ; Joints ; Periosteum ; Range of Motion, Articular ; Splints ; Sutures ; Palmar Plate

BACKGROUND: Continuous positive airway pressure (CPAP) during spontaneous breathing has contributed greatly to the management of the neonatal respiratory distress syndrome and adult respiratory failure associated with acute lung disease. CPAP systems may be grouped into two general categories, demand flow CPAP system and continuous flow CPAP system. The purpose of this study was to evalute the respiratory effects of continuous flow CPAP system compared with demand flow CPAP system. METHODS: Cardiorespiratory values were measured in twelve respiratory failure patients on demand flow CPAP system and continuous flow CPAP system made by authors. CPAP level and FIO2 were maintained at the same level for both modalities. RESULTS: Changing from demand flow CPAP to continuous flow CPAP was associated with significant decrease in tidal volume(demand flow CPAP 450+/-153.0 ml, continuous flow CPAP 338+/-73.8 ml), airway pressure fluctuation(demand flow CPAP 6.4+/-1.2 cmH2O, continuous flow CPAP 2.4+/-0.7 cmH2O) and improvement in arterial oxygen partial pressure (demand flow CPAP 90.0+/-20.9 mmHg, continuous flow CPAP 105.9+/-24.6 mmHg). There were no significant changes in other cardiorespiratory values, such as arterial blood pressure, heart rate and respiratory rate. CONCLUSIONS: These results suggest that continuous flow CPAP system may be a beneficial modality in the management of respiratory failure patients compared to demand flow CPAP system.
Adult ; Arterial Pressure ; Continuous Positive Airway Pressure ; Heart Rate ; Humans ; Lung Diseases ; Oxygen ; Partial Pressure ; Respiration ; Respiratory Distress Syndrome, Newborn ; Respiratory Insufficiency ; Respiratory Rate