• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.17 no.1
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• pp.38-42
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• 2006

Background and Objectives: There has been a gradual decline in the incidence of laryngeal tuberculosis due to effective an-tituberculous chemotherapy and improvement in the standard of living. During the last decade, however, the disease has changed its clinical pattern. We aimed to study a clinical and telescopic evaluation of laryngeal tuberculosis. Materials and Method: A retrospective clinical analysis was done for 16 patients who diagnosed laryngeal tuberculosis from January 2000 through December 2004. All patients had a complete clinical and laboratory work-up including telescopy, chest X-rays, sputum cultures, Tbc PCR(polymerase chain reaction). Laryngeal biopsies were performed in some cases. All the patients received proper antituberculous chemotherapy. Results: The patients age ranged from 21 to 59 with a mean age 43. The male to female ratio was 10:6. The prominent presenting symptom was hoarseness. The various telescopic findings were categorized: 7 patients showed ulcerative, 4 patients granulomatous, 3 patients ulcerofungative, 2 patients had nonspecific inflammatory lesions. Involving sites were true vocal cord most commonly in 12 patients. Three of 16 patients had normal chest X-ray fmding. Among 16 patients, 4 patients showed positive response for AFB stain, 13 patients showed positive for Tbc PCR. Biopsy was done for 3 patients who were not confirmed in initial tuberculous test. All patients responded satisfactorily to antituberculous medication. Conclusion: The telescopic findings and clinical manifestations of laryngeal tuberculosis have changed and seemed to be different from those of classic reports. Thus, the clinicians who deal with the various symptoms and diseases should be aware of the existence of laryngeal tuberculosis and the changing patterns of the disease.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.10 no.2
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• pp.138-146
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• 2007

Purpose: Ischemic enterocolitis (IEC) is the total or partial infarction of the intestine in the absence of occlusion of a major mesenteric blood vessel. The purpose of this study was to evaluate the clinical features of IEC in children. Methods: A clinical analysis of 6 patients with IEC who were admitted to the Department of Pediatrics at Pusan National University Hospital, between 1996 and 2005 was conducted retrospectively. Patients were diagnosed with IEC based on clinical characteristics, including radiologic, endoscopic, histopathologic, and intraoperative findings. Results: Four boys and 2 girls between the age of 6 weeks and 6 years were included in this study. Most of the patients were born at term and had a birth weight that was appropriate for their gestational age. The major symptoms of IEC observed included hematochezia or hematemesis (5 cases), vomiting, diarrhea, abdominal pain or irritability (4 cases), as well as abdominal distension and fever (3 cases). IEC occurred in thecolon in 5 cases (2 descending colon, 1 descending and sigmoid colon, 1 sigmoid colon, 1 whole colon) and the duodenal bulb and gastric antrum in 1 case each. The type of the lesions observed includedulcera, which were found in 3 cases, perforation, which was pbserved in 2 cases, necrotic patches, which were observed in 2 cases, stricture, which was observedin 1 cases, and massive membranous desquamation of the epithelium, which was observed in 1 case. Two of the patients received surgical treatment and the remaining four were treated conservatively. None of the patients died. Conclusion: The presentation of IEC varies, and the findings of this study will be helpful in managing patients with IEC.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.6 no.1
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• pp.1-9
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• 2003

Purpose: To investigate the relation of the gastric epithelial cell proliferation, apoptosis and genotypes of H. pylori in children. Methods: Histologic grading by updated Sydney system, PCNA immunostaining, TUNEL method and the genotypes (cagA, picB and iceA) by PCR were performed in H. pylori positive (N=20) and negative (N=20) gastric biopsy specimens. Results: PCNA index was significantly different between H. pylori positive children ($77.4{\pm}13.12$) and H. pylori negative children ($52.3{\pm}12.20$) (p=0.000). There were positive correlations between PCNA index and H. pylori density (r=0.624, p=0.000), polymorphonuclear neutrophil activity (r=0.460, p=0.005) and chronic inflammation (r=0.433, p=0.009). Apoptosis index of H. pylori positive children ($0.70{\pm}0.411$) was significantly higher than of H. pylori negative children ($0.14{\pm}0.201$) (p=0.000). Positive correlations between apoptosis index and H. pylori density (r=0.691, p=0.000), polymorphonuclear neutrophil activity (r=0.585, p=0.000) and chronic inflammation (r=0.535, p=0.001) were noted. As PCNA index increased, apoptosis index significantly increased (r=0.527, p=0.001). The positive rates of genotypes were cagA 90%, picB 75%, iceA1 60% and iceA2 15%, respectively. There were no significant correlations between the status of the genotypes and PCNA index, apoptosis index, the endoscopic findings and the histologic findings. Conclusion: PCNA index and apoptosis index in H. pylori positive children were higher than in H. pylori negative children but were not related to H. pylori genotypes. This study suggested that correlatively increased gastric epithelial cell proliferation and apoptosis are important to pathogenesis of H. pylori infection in children.

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.991-997
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• 2005

Purpose : Cow's milk protein-induced enterocolitis(CMPIE) is a symptom complex of vomiting and/or diarrhea caused by delayed hypersensitivity and may result in serious complications. This study was undertaken to identify high risk factors to facilitate the early recognition of CMPIE. Methods : We reviewed the data of 101 patients, aged 15 to 45 days, admitted due to vomiting and/or diarrhea between 2003 and 2004. After excluding 13 patients absolutely breast-fed and 2 patients transferred from other hospitals with the impression of CMPIE, the 86 study subjects were divided into three groups based on the underlying etiologies; CMPIE, infectious and non-infectious group. Results : CMPIE was diagnosed in 11 patients(12.8%). On admission, failure to gain weight(P=0.003), hypoalbuminemia(P=0.003), peripheral leukocytosis(P=0.015), and metabolic acidosis(P=0.014) were more significant in the CMPIE group than in the others. Multiple logistic regression analysis showed that the independent predictors of high risks for CMPIE were failure to gain weight <10 g/day(OR, 10.25[95% CI, 1.62-65.06]) and serum hypoalbuminemia <3.5 g/dL(OR, 9.18[95% CI, 1.69-49.74]). Cow's milk challenges were performed in the 11 CMPIE patients; vomiting(81.8%), abnormal stool test(80.0%), peripheral leukocyte count and absolute neutrophil count(ANC) increase(100.0%) (P<0.05), and enteropathy(100.0%). Conclusion : CMPIE is not a rare clinical disease in early infancy. The high risk factors of CMPIE were identified as follow : failure to gain weight below 10 g/day, hypoalbuminemia on admission and a rapid decrease during admission. Cow's milk challenge test with endoscopic duodenal biopsy was helpful to confirm CMPIE.

• Tuberculosis and Respiratory Diseases
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• v.60 no.6
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• pp.653-662
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• 2006

Background: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods. Methods: From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared. Results: 37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial $PaO_2/$FiO_2$ratio and COHb were $286.4{\pm}129.6mmHg$ and $7.8{\pm}6.6%$. Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal. Conclusions: Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period.

• Investigative Magnetic Resonance Imaging
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• v.5 no.1
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• pp.18-23
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• 2001

Purpose : To describe the MRI findings in the bronchial anthracofibrosis mimicking lung cancer on CT examination. Materials and methods : Ten patients, who showed CT findings mimicking lung cancer, were selected among fifty patients of bronchial anthracofibrosis proven by bronchoscopic biopsy, consisting of two men and eight women, ranging in age from 58 to 79 years old faverage age, 68 years old). CT scan and MRI were performed in all patients (n=10). Percutaneous lung biopsy on mass was performed in one patient. MRI findings were analyzed with the emphasis on the signal intensity of the mass (n=4), collapsed lung (n=4) and Iymph node (n=10) on axial T1 and T2-weighted images by two radiologists in consensus. No contrast enhancement was used in all cases. Results : CT scan revealed mass (n=4), atelectasis with obstructive pneumonia(n=4) and bronchial wall thickening(n=2). All patients showed enlarged medistinal Iymph nodes(n=10). The mass showed low signal intensity on T1WI and T2WI (n =4). The collapsed lung in patients with atelectasis indicated intermediate signal intensity on T1WI and low signal intensity on T2WI (n= 4). Nine patients showed low sisnal intensity of Iymph node on T1WI and T2WI, except one patient who showed central high signal intensity with peripheral rim of low signal intensity in right lower paratracheal llmph node on T2WI. Conclusion : Low signal intensity of a mass, collapsed lung, and lymph nodes on T2WI in anthracofibrosis patients may be helpful in differentiation of the lesion from lung cancer.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.568-572
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• 2008

Background: Minimally invasive surgery is currently popular, but this has been applied very sparingly to cardiac surgery because of some limitations. Our study evaluated the safety and efficacy of atrial septal defect (ASD) closure through a video-assisted mini-thoracotomy. Material and Method: Fifteen patients were analyzed. Their mean age was $31{\pm}6$ years. The mean ASD size was $24{\pm}5mm$ and there were 3 cases of significant tricuspid regurgitation. The working window was made through the right 4th intercostal space via a $4{\sim}5cm$ inframammary skin incision, CPB was conducted with performing peripheral cannulation. After cardioplegic arrest, the ASDs were closed with a patch (n=11) or direct sutures (n=4), and the procedures were assisted by using a thoracoscope. There were 3 cases of tricuspid repair and 1 case of mitral valve repair. The mean CPB time and aortic occlusion time were $160{\pm}47\;and\;70{\pm}26 $minutes, respectively. Result: There was no mortality, but there were 3 minor complications (one pneumothorax, one wound dehiscence and one arrhythmia). The mean hospital stay was $5.9{\pm}1.8$ days. The mean follow-up duration was $10.7{\pm}6.4$ months. The follow-up echocardiogram noted no residual ASD or significant tricuspid regurgitation. Three patients suffered from pain or numbness. Conclusion: This study showed satisfactory clinical and cosmetic results. Although the operative time is still too long, more experience and specialized equipment would make this technique a good option for treating ASD.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.199-206
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• 2009

Purpose: To analyze the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after liver transplantation in children. Methods: From January 1988 to June 2009, we retrospectively reviewed the medical records of 8 PTLD cases among 148 pediatric patients underwent liver transplantation. The age at transplantation, time of presentation after transplantation, clinical manifestations, histologic diagnosis, results of EBV (Epstein-Barr virus) assessments, managements and outcomes of PTLD were investigated. Results: The prevalence of PTLD in liver transplant pediatric recipients was 5.4% (8 of 148). The mean age of patients was 25.4${\pm}$21.3 months (range 10 to 67 months). Seven of 8 patients (87.5%) underwent liver transplantation before 1 year of age. The common clinical presentations were persistent fever (8 of 8, 100%) and bloody diarrhea (6 of 8, 75%). PTLD was diagnosed with gastrointestinal endoscopic biopsies in five patients and surgical biopsies in three. Histologic findings showed early lesion in three patients, polymorphic in two, and monomorphic in three. Burkitt lymphoma and lymphoblastic lymphoma were found in two of 3 monomorphic patients. Seven of 8 patients were found with EBV-positive. Eight patients were treated with dose reduction of immunosuppressants and infusion of ganciclovir. Rituximab was added to four patients. PTLD were successfully managed in all patients except one who died of sepsis during chemotherapy. Conclusion: Major risk factor of PTLD was to undergo liver transplantation before 1 year of age. Continuous monitoring for EBV viral load and gastrointestinal endoscopic biopsy may be useful to early detection of PTLD.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.217-222
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• 2002

Background: The incidence of gastroesophageal reflux disease(GERD) is increasing recently, but medical management for GERD has many limitations. Therefore, variable surgical treatments have been introduced. Material and Method: A retrospective study was done in 10 patients who underwent the Belsey Mark IV operation at Korea university Guro hospital between 1996 and 2001. Preoperative diagnoses were hiatal hernia with gasroesophageal reflux in 8 patients and achalasia in 2 patients. Result: Mean age of the patients was 54.3$\pm$19.0 years. Belsey Mark IV operation was performed on patients where preoperative medical failed and mean hospital days were 13.1$\pm$2.6 days. We routinely practiced follow-up endoscopy on postoperative 3rd, 6th, 9th, and 12th months. After remission for reflux and esophagitis, they were transferred to internal medicine department. Six patients of hiatal hernia with reflux (one patient who lost follow-up and the other patient who didn't practice the follow-up endoscopy due to short postoperative follow-up period were excluded) had lowered endoscopic gradings and two patients of achalasia did not complained of reflux symptoms, postoperatively. We experienced 10% operation failure rate. Conclusion: We experienced satisfactory operation results with Belsey Mark IV in hiatal hernia with GERD and achalasia patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.1
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• pp.19-25
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• 2002

Purpose: The triple therapy with proton pump inhibitor (PPI) has been recognized as the treatment of choice in Helicobacter pylori (H. pylori) infection in adults. However, the effect of triple therapy with omeprazole, amoxicillin and clarithromycin (OAC) on eradication of H. pylori infection in children has not been established yet. This study was performed to evaluate the efficacy of OAC triple therapy and to compare the effect of one-week with two-week therapy on H. pylori eradication. Methods: From July 1998 to July 2000, 34 children with upper gastrointestinal symptoms, who underwent upper gastrointestinal endoscopy with biopsy at entry and 4 or more weeks after therapy, were enrolled in this study. H. pylori infection was assessed by CLO test and histologic examination (Hematoxylin-Eosin stain or Alcian yellow stain) with biopsy specimens. The regimen consisted of omeprazole (0.7 mg/kg/day), amoxicillin (50 mg/kg/day), and clarithromycin (25 mg/kg/day) for 1 week (n=21) or 2 weeks (n=13). Eradication of H. pylori was determined after the termination of treatment by the CLO test and histologic examination. Results: One-week treatment group consisted of 21 children (11 male, 10 female) with a mean age of $9.5{\pm}3.0$ years. Two-week group consisted of 13 children (4 male, 9 female) with a mean age of $9.9{\pm}4.0$ years. The endoscopic diagnoses included nodular gastritis in 19 cases, superficial gastritis in 7 cases, gastric ulcer in 4 cases, purpuric duodenitis in 2 cases, and normal in 2 cases. H. pylori was eradicated in 28 of total 34 children (82.4%). In 1-week group, H. pylori was eradicated in 17 of 21 children (81%). In 2-week group, H. pylori was eradicated in 11 of 13 children (84.6%). In remaining 6 cases in whom H. pylori had not been eradicated with OAC regimen, H. pylori infection persisted despite of the treatment with additional drugs such as colloidal bismuth subcitrate ($Denol^{(R)}$) and metronidazole. Conclusion: In this study, eradication rate of H. pylori with OAC regimen was 82.4%, and the triple therapy would be highly effective as primary treatment. However, there was no significant difference in the eradication rate between the 1-week and 2-week treatment group (P=0.785).