Gastric hemangioma in the neonatal period is a very rare cause of upper gastrointestinal bleeding. We present a case of hemangioma limited to the gastric cavity in a 10-day-old infant. A huge, erythematous mass with bleeding was observed on the lesser curvature side of the upper part of the stomach. Surgical resection was ruled out because the location of the lesion was too close to the gastroesophageal junction. Medical treatment with intravenous H₂ blockers, octreotide, packed red blood cell infusions, local epinephrine injection at the lesion site, application of hemoclip, and gel-form embolization of the left gastric artery did not significantly alter the transfusion requirement. Hemostasis was achieved with endoscopic argon plasma coagulation (APC). After two sessions of APC, complete removal of the lesion was achieved. APC was a simple, safe and effective tool for hemostasis and the ablation of gastric hemangioma without significant complications.
Argon Plasma Coagulation* ; Argon* ; Arteries ; Epinephrine ; Erythrocytes ; Esophagogastric Junction ; Hemangioma* ; Hemorrhage ; Hemostasis ; Humans ; Infant ; Infant, Newborn* ; Octreotide ; Stomach

Noroviruses have been recognized as the leading cause of epidemic and sporadic gastroenteritis since the advent of molecular diagnostic technique. They have been documented in 5-31% of pediatric patients hospitalized with gastroenteritis. Although norovirus gastroenteritis is typically mild and self-limited, it causes severe, but sometimes fatal, conditions in the vulnerable population such as immunocompromised patients, young children, and the elderly. Bowel perforation due to norovirus infection is rare. We report a case of small bowel perforation with norovirus gastroenteritis in the infant with Down syndrome during the hospitalization with pneumonia. Severe dehydration may cause bowel ischemia and could have triggered bowel perforation in this case. Physicians should be alert to the potential surgical complications followed by severe acute diarrhea, especially in high risk groups.
Aged ; Child ; Dehydration ; Diarrhea ; Down Syndrome ; Gastroenteritis* ; Hospitalization ; Humans ; Immunocompromised Host ; Infant* ; Ischemia ; Molecular Diagnostic Techniques ; Norovirus* ; Pneumonia ; Vulnerable Populations

Mycoplasma pneumoniae infections mainly involve respiratory tract; however, also can manifestate other symptoms by site involved. Extrapulmonary manifestations of M. pneumoniae infection are rarely known to occur without pneumonia. Herein we report a case of a 9-year-old boy who presented with acute cholestatic hepatitis in the absence of pneumonia. Rhabdomyolysis, skin rash, and initial laboratory results suspicious of disseminated intravascular coagulopathy were also observed in this patient. M. pneumoniae infection was identified by a 4-fold increase in immunoglobulin G antibodies to M. pneumoniae between acute and convalescent sera by enzyme-linked immunosorbent assay. This is the first pediatric case in Korea of M. pneumoniae infection presenting with acute cholestatic hepatitis in the absence of pneumonia.
Antibodies ; Child ; Enzyme-Linked Immunosorbent Assay ; Exanthema ; Hepatitis* ; Humans ; Immunoglobulin G ; Korea ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Respiratory System ; Rhabdomyolysis

PURPOSE: The goal of this study was the early diagnosis of ABCB11 spectrum liver disorders, especially those focused on benign recurrent intrahepatic cholestasis and progressive familial intrahepatic cholestasis. METHODS: Fifty patients presenting neonatal cholestasis were evaluated to identify underlying etiologies. Genetic analysis was performed on patients suspected to have syndromic diseases or ABCB11 spectrum liver disorders. Two families with proven ABCB11 spectrum liver disorders were subjected to genetic analyses to confirm the diagnosis and were provided genetic counseling. Whole exome sequencing and Sanger sequencing were performed on the patients and the family members. RESULTS: Idiopathic or viral hepatitis was diagnosed in 34%, metabolic disease in 20%, total parenteral nutrition induced cholestasis in 16%, extrahepatic biliary atresia in 14%, genetic disease in 10%, neonatal lupus in 2%, congenital syphilis in 2%, and choledochal cyst in 2% of the patients. The patient with progressive familial intrahepatic cholestasis had novel heterozygous mutations of ABCB11 c.11C>G (p.Ser4*) and c.1543A>G (p.Asn515Asp). The patient with benign recurrent intrahepatic cholestasis had homozygous mutations of ABCB11 c.1331T>C (p.Val444Ala) and heterozygous, c.3084A>G (p.Ala1028Ala). Genetic confirmation of ABCB11 spectrum liver disorder led to early liver transplantation in the progressive familial intrahepatic cholestasis patient. In addition, the atypically severe benign recurrent intrahepatic cholestasis patient was able to avoid unnecessary liver transplantation after genetic analysis. CONCLUSION: ABCB11 spectrum liver disorders can be clinically indistinguishable as they share similar characteristics related to acute episodes. A comprehensive genetic analysis will facilitate optimal diagnosis and treatment.
Biliary Atresia ; Choledochal Cyst ; Cholestasis ; Cholestasis, Intrahepatic ; Diagnosis ; Early Diagnosis* ; Exome ; Genetic Counseling ; Hepatitis ; High-Throughput Nucleotide Sequencing ; Humans ; Hyperbilirubinemia ; Jaundice ; Liver Transplantation ; Liver* ; Metabolic Diseases ; Parenteral Nutrition, Total ; Syphilis, Congenital

Cholelithiasis and choledocholithiasis are uncommon pediatric diseases, although clinicians have seen them with increasing frequency in children in recent years. Moreover, no case of Epstein-Barr virus (EBV) infection with cholelithiasis and choledocholithiasis has been previously reported in the English literature. We report a pediatric patient with EBV infection, a gall bladder stone, and a common bile duct stone, may have had GB and CBD stones prior to her EBV infection, whom we successfully treated with antibiotics and laparoscopic cholecystectomy for cholecystitis.
Anti-Bacterial Agents ; Child ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Choledocholithiasis ; Cholelithiasis ; Common Bile Duct ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; Humans ; Urinary Bladder ; Urinary Bladder Calculi

Congenital esophageal stenosis (CES) can be classified into three types based on the etiology of stenosis: tracheobronchial remnants (TBRs), fibromuscular hypertrophy (FMH), and membranous diaphragm (MD). It is important to make a differential diagnosis because the therapeutic plan for CES is determined by its etiology. Most cases of FMH and MD can be managed with balloon dilatation, whereas cases of TBRs require resection and anastomosis. Thus, the preoperative distinction of TBRs is critical. Recently miniprobe endoscopic ultrasonography (EUS) with a maximum diameter of 2.5 mm has been useful for distinguishing TBRs from FMH in pediatric patients with CES. EUS shows hyperechoic lesions indicating TBR cartilage. Miniprobe EUS is recommended for choosing the correct therapeutic method for CES. We report a case of CES due to TBRs in which a preoperative diagnosis was made in a child using miniprobe EUS without any difficulties.
Cartilage ; Child ; Diagnosis, Differential ; Diaphragm ; Dilatation ; Endosonography ; Esophageal Stenosis ; Humans ; Hypertrophy

PURPOSE: Tumor necrosis factor-alpha (TNF-alpha) polymorphism has been suggested to play an important role in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) in obese adults, and known to be a mediator of insulin resistance. In this study, we evaluated the role of TNF-alpha promoter polymorphisms and insulin resistance in the development of NAFLD in obese children. METHODS: A total of 111 obese children (M:F=74:37; mean age, 11.1+/-2.0 yrs) were included. The children were divided into 3 groups: controls (group I, n=61), children with simple steatosis (group II, n=17), and children with non-alcoholic steatohepatitis (group III, n=33). Serum TNF-alpha levels, homeostasis model assessment of insulin resistance (HOMA-IR), and TNF-alpha -308 and -238 polymorphisms were evaluated. RESULTS: There were no differences in TNF-alpha polymorphism at the -308 or the -238 loci between group I and group II + III (p=0.134 and p=0.133). The medians of HOMA-IR were significantly different between group I and group II + III (p=0.001), with significant difference between group II and group III (p=0.007). No difference was observed in the HOMA-IR among the genotypes at the -308 locus (p=0.061) or the -238 locus (p=0.207) in obese children. CONCLUSION: TNF-alpha promoter polymorphisms at the -308 and -238 loci were not significantly associated with the development of NAFLD in children; nevertheless, insulin resistance remains a likely essential factor in the pathogenesis of NAFLD in obese children, especially in the progression to NASH.
Adult ; Child ; Fatty Liver ; Genotype ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Obesity ; Tumor Necrosis Factor-alpha

PURPOSE: Epstein-Barr virus (EBV) hepatitis is a usually asymptomatic and self-limiting disease in immunocompetent patients. However, the range of severity is wide, and the serological diagnosis is typically difficult until the convalescent phase. Thus, we examined the value of plasma EBV DNA real-time quantitative polymerase chain reaction (RT-qPCR) in EBV hepatitis for the timely diagnosis and the relationship between EBV viral load and clinical severity. METHODS: Sixty samples were confirmed as having EBV infection by RT-qPCR with the EBV BALF5 gene sequence. We examined the clinical characteristics of EBV hepatitis by reviewing medical records. RESULTS: The median total duration of fever was 8 days (range: 0-13 days). The mean peak value of aspartate aminotransferase (AST) was 241+/-214 U/L, and the mean peak value of alanine aminotransferase (ALT) was 298+/-312 U/L. There was no correlation between the serum levels of liver enzyme and plasma EBV DNA titer (p=0.1) or between median total duration of fever and EBV DNA titer (p=0.056). The median age of the EBV VCA IgM-negative group was lower compared with the EBV VCA IgM-positive group in EBV hepatitis (2 years vs. 6 years, p=0.0009). CONCLUSION: The severity of EBV hepatitis does not correlate with circulating EBV DNA load according to our data. Furthermore, we suggest that plasma EBV PCR may be valuable in young infants in whom the results of serology test for EBV infection commonly are negative.
Alanine Transaminase ; Aspartate Aminotransferases ; DNA ; Epstein-Barr Virus Infections ; Fever ; Hepatitis ; Herpesvirus 4, Human ; Humans ; Infant ; Liver ; Plasma ; Polymerase Chain Reaction ; Viral Load

PURPOSE: To examine the prevalence of Clostridium difficile (C. difficile) colonization (CDC) and potential neonatal determinants of CDC in hospitalized preterm infants. METHODS: Fecal samples were serially collected within 72 h after birth and at 1, 2, and 4-6 weeks of age from preterm infants in the neonatal intensive care units (NICUs) of two different university hospitals. Total bacterial DNA was extracted from each fecal sample from 49 infants, and polymerase chain reaction (PCR) was performed with primers for the 16S gene of C. difficile and the toxin A and toxin B genes. The correlation between the results of C. difficile PCR assays and the clinical characteristics of the infants was analyzed. RESULTS: The prevalence rates of CDC were 34.7, 37.2, 41.3, and 53.1% within 72 h after birth and at 1, 2, and 4-6 weeks of age, respectively. The toxin positivity rate was significantly higher in the infants with persistent CDC than in those with transient CDC (8/12 [66.7%] vs. 6/25 [24.5%] (p=0.001). Among the various neonatal factors, only the feeding method during the first week after birth was significantly associated with persistent CDC. Exclusive breast-milk feeding (EBMF) significantly decreased the risk of persistent CDC compared to formula or mixed feeding (adjusted odds ratio: 0.133, 95% confidence interval: 0.02-0.898, p=0.038). CONCLUSION: The prevalence of CDC increased with the duration of hospitalization in preterm infants in the NICU. EBMF during the first week after birth in hospitalized preterm infants may protect against persistent CDC.
Centers for Disease Control and Prevention (U.S.) ; Clostridium ; Clostridium difficile ; Colon ; DNA, Bacterial ; Feeding Methods ; Hospitalization ; Hospitals, University ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Parturition ; Polymerase Chain Reaction ; Prevalence

PURPOSE: Interest in peptic ulcer in children has been relatively low because the disease is rarer in children than in adults and there were restrictions in the application of endoscopy to children, but the recent development of pediatric endoscopy is activating research on pediatric peptic ulcer. Thus, this study compared the H. pylori infection rate and clinical and endoscopic findings among pediatric patients diagnosed with peptic ulcer. METHODS: We analyzed retrospectively 58 pediatric patients for whom whether to be infected with H. pylori was confirmed selected out of pediatric patients diagnosed with gastric ulcer or duodenal ulcer through upper gastrointestinal endoscopy at the Department of Pediatrics of Gachon University Gil Hospital during the period from January 2002 to December 2007. A case was considered H. pylori positive if H. pylori was detected in the Giemsa stain of tissue or the results of UBT (urea breath test) and CLO (rapid urease test) were both positive. RESULTS: Of the pediatric patients, 37 were infected with H. pylori and 21 were not. The H. pylori infection rate increased with aging and the result was statistically significant (p<0.05). However, H. pylori infection was not in a statistically significant correlation with sex, chief complaint, and gastroduodenal ulcer (p>0.05). CONCLUSION: H. pylori infection increased with aging, but was not significantly correlated with gastroduodenal ulcer. Further research may need to examine prospectively the relation between H. pylori and gastroduodenal ulcer in the Incheon area.
Adult ; Aging ; Azure Stains ; Child ; Duodenal Ulcer ; Endoscopy ; Endoscopy, Gastrointestinal ; Helicobacter ; Helicobacter pylori ; Humans ; Pediatrics ; Peptic Ulcer ; Retrospective Studies ; Stomach Ulcer ; Urease