• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.3
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• pp.235-243
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• 2022

Backgrounds/Aims: Historically, the incidence and prognosis of patients diagnosed with intrahepatic cholangiocarcinoma (ICC) have been inadequately understood. Survival analysis in ICC has yet to be investigated in a population-based study. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results Program (SEER) 18 Registry. Risk ratios were estimated via Poisson regression. Hazard ratios for 5-year survival were estimated using hierarchical Cox regression models. Results: Males show a higher rate of age-adjusted ICC incidence. Blacks carried a decreased risk of ICC diagnosis than Whites, while Asians revealed a higher risk of ICC diagnosis when compared with Whites. The observed survival rates at 12, 36, and 60 months were 36.3%, 12.8%, and 8.1%, respectively. Compared with Whites, Blacks showed an increased risk of death (p < 0.01). Lymph node resection during surgery was associated with a 64.1% reduced risk of mortality (p < 0.01). A higher T stage at diagnosis was associated with poor survival (p < 0.01). Surgery combined with chemoradiotherapy, radiotherapy, or chemotherapy was associated with a reduced risk of mortality compared with nonsurgical interventions (p < 0.01). Conclusions: ICC incidence has been increasing since 2000, especially in White males. The risk of ICC rises with age. Lymph node removal is associated with better survival. In recent years, survival had worsened, and surgical intervention improved survival compared with nonsurgical management.

• Journal of Korean Academy of Nursing
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• v.54 no.3
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• pp.386-402
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• 2024

Purpose: The purpose of this study was to conduct a pre-conception care program for women of childbearing age with inflammatory bowel disease (IBD) in Korea and verify its effects on self-efficacy for IBD management, IBD-related pregnancy knowledge, and IBD-related pregnancy anxiety. It also aimed to explore the changes in participants through the program. Methods: A convergent mixed-methods study design was adopted. In the quantitative phase, 35 women (17 and 18 in the intervention and control group, respectively) participated. The intervention group attended a program that included small-group sessions and individual tele-coaching. To confirm the effects, data were collected before and one and four weeks after the intervention. In the qualitative stage, focus group interviews and tele-coaching were conducted with the intervention group. Results: After the program ended, significant differences were observed over time between the intervention and control groups for self-efficacy for IBD management (Wald χ² = 4.41, p = .036), IBD-related pregnancy knowledge (Wald χ² = 13.80, p < .001) and IBD-related pregnancy anxiety (Wald χ² = 8.61, p = .003). Qualitative data analysis revealed the following themes: (1) improving confidence in IBD management and awareness for planned pregnancy; (2) improving IBD awareness related to pregnancy and childbirth; and (3) relieving anxiety about and actively facing pregnancy. Conclusion: This study is meaningful in that, to the best of our knowledge, it is the first to develop a pre-conception care program for women diagnosed with IBD and confirm its effectiveness. Furthermore, this program is expected to be suitable for patient counseling and education in clinical practice.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.4 no.2
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• pp.133-141
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• 2001

Purpose: Gastroesophageal reflux (GER) has been found to be the causative factors of apnea, stridor, feeding intolerance, poor weight gain, and sudden infants death syndrome (SIDS) in infants. GER is a well-described in infants and children, but only scant mention of the premature infants with GER can be found in the literature. Methods: Esophageal pH was measured during 24 hour in 21 healthy preterm infants, using a silicone microelectrode with an external reference electrode connected to a portable recorder. The mean age of the patients was $29{\pm}8$ days, mean gestational age was $30^{+5}{\pm}2^{+0}$ weeks, mean birth weight was $1,468{\pm}329$ g, mean postconceptional age was $34^{+6}{\pm}1^{+4}$ weeks and mean weight was $1,750{\pm}329$ g. We evaluated the following reflux parameters; number of acid reflux, number of long acid reflux, longest acid reflux minutes, and reflux index. Results: Pathologic GER was detected in 12 (57%) subjects and most interesting parameters are reflux index and number of episodes with a pH<4 during 24 hour (high correlation with postprandial reflux index). Reflux was not correlated to gestational age, birth weight, age, postconceptional age, weight, sex and medication of the theophylline. Conclusion: Gastroesophageal reflux is common in preterm infants, but it is usually not apparent, even with severe reflux.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.4 no.2
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• pp.181-190
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• 2001

Purpose: The aim of this study is to investigate the usefulness of intestinal ultrasonography (US) and upper gastrointestinal endoscopy in the early diagnosis of Henoch-Sch$\"{o}$nlein purpura (HSP) with the gastrointestinal (GI) symptoms preceding the emergence of the skin lesion. Methods: The clinical, intestinal US and upper gastrointestinal endoscopic records of 85 patients (88 cases) with GI symptoms relating to HSP presenting between January 1999 and April 2001 were reviewed. Results: 1) GI symptoms were observed in 52 cases (59%) and skin, joint, renal and scrotal manifestations were observed in 88 (100%), 64 (73%), 15 (17%), 3 cases (3%) respectively. 2) Out of 52 cases with GI symptoms, abdominal pain was observed in all cases (100%). Positive stool occult blood, nausea and vomiting, abdominal tenderness, melena or tarry stool, diarrhea, hematemesis, rebound tenderness and rigidity were observed in 28 (50%), 17 (33%), 17 (33%), 12 (23%), 6 (12%), 4 (8%), 1 (2%) and 1 case (2%) respectively in order of frequency. 3) Intestinal US examination was performed in 27 cases with HSP and GI symptoms (52 cases). Out of 27 sonographic examinations 22 showed abnormal findings. Thickening of the duodeno-jejunal wall was observed in 16 cases (73%). Free peritoneal fluid, enlarged mesenteric lymph node, ileus and abnormal gall bladder were seen in 8 (36%), 8 (36%), 4 (18%) and 1 case (5%) respectively. In three cases of HSP without GI symptoms, those changes were absent. 4) In all of five cases with HSP and GI symptoms, endoscopic study showed mucosal edema and multiple hemorrhagic erosions especially at the second portion of the duodenum. Biopsy specimens from the duodenum of 2 cases out of 5 endoscopic examinations showed acute inflammatory infiltrates in the mucosa with hemorrhage. 5) Both intestinal US and endoscopic studies were performed in 4 cases with HSP and GI symptoms simultaneously. Out of 4 those cases, 3 cases showed the thickened duodeno-jejunal wall on the intestinal US, which suggested erosive hemorrhagic duodenitis by endoscopic findings. Conclusion: The typical but nonpathognomonic intestinal US findings including the thickening of the duodeno-jejunal wall and upper gastrointestinal endoscopic findings including hemorrhagicerosive duodenitis, in children with GI symptoms, should be considered a manifestation of HSP, even in the absence of skin lesion.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.4 no.2
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• pp.167-174
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• 2001

Purpose: Adenovirus infection with swollen Peyer patches in the ileum, known as one of the causes of intussusception, may cause vitamin C depletion in human body because vitamin C is a first line antioxidant. Or low vitamin C status in human body makes the man more susceptible to infection of adenovirus in the ileum with a markedly swollen lymph node. In this study, we tried to find out the relationship between pediatric intussusceptions and vitamin C concentrations of whole blood and plasma. Methods: Whole blood and plasma vitamin C concentrations of fifty-seven patients with intussusceptions from May 1995 to December 1998 at the Gyeongsang National University Hospital were compared with those of 256 normal healthy children. Vitamin C was measured by the 2, 4-dinitrophenylhydrazine methods. Results: The average age of patients (male=39, female=18) with intussusceptions was fifteen months of age. Whole blood vitamin C concentrations of patients and healthy children were $1.49{\pm}0.64$ mg/dL, and $2.18{\pm}0.49$ mg/dL, respectively. Plasma vitamin C concentrations of patients and healthy children were $0.59{\pm}0.36$ mg/dL, $1.47{\pm}0.56$ mg/dL, respectively. But no differences in the vitamin C concentrations of whole blood and plasma according to age, degree of leukocytosis, fever, interval from onset, hematochezia, and need for operation were found. Conclusion: Whole blood and plasma vitamin C concentrations of patients with intussusceptions were lower than those of healthy children (P=0.0001). Prospective studies are needed to elucidate whether these results were consequences or causes of intussusceptions.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.4 no.2
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• pp.191-198
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• 2001

Purpose: This study was undertaken to investigate the seroepidemiologic pattern of Helicobacter pylori (H. pylori) and hepatitis A virus (HAV) infections in children. Methods: A total of 315 serum samples were obtained from healthy children, living in Gwangju and Chonnam area. All serum samples were assayed for H. pylori IgG level using enzyme immunoassay techniques. HAV IgG level in serum were tested by a competitive radio-immunoassay in 215 subjects. The age-specific seroprevalence of H. pylori and HAV was separately analysed. The concordance of seropositivity and seronegativity between H. pylori and HAV infection was examined by the kappa statistic analysis. Results: Seropositivity was found in 17.5% (55/315) and 30.2% (65/215) of the subjects for H. pylori and HAV, respectively. Cross-tabulation of these data showed that 21 subjects (9.8%) were seropositive and 135 (62.8%) were seronegative for both H. pylori and HAV, 15 (7.0%) were seropositive for only H. pylori and 44 (20.5%) for only HAV. The seroprevalence of H. pylori and HAV increased significantly with age. There was a slight agreement between H. pylori and HAV seropositivity (${\kappa}$=0.26). Conclusion: This study shows a slight similarity in the concordance of seropositivity and seronegativity between H. pylori and HAV infection and provides evidence that H. pylori and HAV may share a common mode of transmission.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.4 no.2
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• pp.207-212
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• 2001

Purpose: Mycoplasma pneumoniae infection is relatively common in childhood. Its extrapulmonary manifestations have been reported so much, but hepatitis associated with it has not been studied yet until now in Korea. Methods: We performed the prospective study of 19 cases that had AST and ALT>50 IU/L respectively without evidence of hepatitis A, B, C, cytomegalovirus, and Ebstein-Barr virus infections amongst 143 patients with M. pneumoniae pneumonia who were admitted to the Department of Pediatrics, Seoul Red Cross Hospital from Jan. 1999 to Dec. 2000. Results: 1) Hepatitis occurred in 13.3% of Mycoplasma pneumoniae infection, especially in fall and winter times. The average age was 4.86 years and male to female ratio was 2.2:1. 2) Vomiting was developed in 21.1%, diarrhea in 36.8%, and hepatomegaly in 21.1%, respectively. And leukocytosis was noted in 21.1%, eosinophilia in 15.4%, anemia in 10.5%, and thrombocytosis in 5.3%, respectively. The average level of C-reactive protein was $6.34{\pm}4.82$ mg/dl. 3) There was no hyperbilirubinemia, but hypoalbuminemia was detected in 42.1%. The average serum levels of AST and ALT were $214.05{\pm}183.22$ IU/L and $284.16{\pm}286.84$ IU/L, respectively. 4) Chest radiology showed lobar or lobular consolidation in 73.7%, bronchial infiltration in 26.3%, and pleural effusion in 31.6%. 5) The average length of hospitalization was 7.9 days, and the average length of normalization of serum transaminases was 8.8 days. All patients recovered within 2 weeks completely. Conclusion: The prognosis of M. pneumoniae hepatitis is good. However, its incidence is not so low that liver function should be considerately checked in case of M. pneumoniae infection.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.6 no.1
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• pp.47-53
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• 2003

Purpose: We studied the prevalence and long-term trend of childhood obesity after puberty to help in managing and treating obesity. Methods: We surveyed obesity index of children at age 13 and 17 who was diagnosed as obesity at their age 7. 1,559 students consisting of 753 boys and 806 girls had followed up since 1992 until 2002. Obesity was defined as the obesity index over 20 percent. Results: The prevalence of obesity was 3.1% at age 7, 7.1% at age 13 and 13.0% at age 17, which increased significantly with getting older in age in both sex. Among obese children at age 7, 67.5 percent remained obese at age 17. 66.6% of the obese boys at age 7 and 68.4% of the obese girls at age 7 remained obese at age 17. The proportion of severe obesity in obese boys was increased as they were old, but not in obese girls. The progression to moderate and severe obesity at age 17 was prominent for obese boys at age 7, compared to the obese girls. 12.7% of normal weight boys at age 7 and 9.8% of normal weight girls at age 7 became obese at age 17. Conclusion: We think that the prevention and treatment of obesity during puberty is as important as those in the childhood.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.6 no.1
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• pp.10-16
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• 2003

Purpose: To evaluate the risk of gastrointestinal bleeding associated with use of low-dose aspirin in children. Methods: Among about 250 children who received low-dose aspirin (5 mg/kg/day) under the diagnosis of Kawasaki disease, from March 1995 to May 2001, at Eul-Ji general hospital, 100 children were enrolled in this study. We reviewed the medical records and interviewed the children's parents over the phone to confirm the existence of gross gastrointestinal bleeding. Results: The age of the children at the beginning of medication ranged 4~118 months. About 75% of them was younger than 3 years old. The duration of medication ranged 0.5~17 months. About 70% of the children took the medicine for 2~3 months. Only 1 child (1%) had hematochezia during medication without any accompanying gastrointestinal symptom, and cimetidine for 1 week had cleared up the bleeding. The total duration of medication of 100 children was 341.5 months, and only 1 child had gastrointestinal bleeding. This translates into a rate of clinically significant gastrointestinal bleeding of 3.5 episodes/100 children/year. Conclusion: The long-term use of low-dose aspirin is safe, but, is associated with the risk of gastrointestinal bleeding in children. Careful follow-up and efforts to reduce the risk of gastrointestinal bleeding are necessary during long-term low-dose aspirin therapy in children.

• 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.