[Show abstract][Hide abstract] ABSTRACT: Background and Aims: Intussusception is the one of the most common acute abdomen in children. Ultrasound is being increasingly used the diagnosis of intussuscption. Ultrasound was performed by gastroenterologists at our hospital but not available at night and holidays. The ultrasound training was conducted for pediatric emergency physician. We analyzed our experience to evaluate the validation of ultrasound performed by pediatric emergency physician for the diagnosis of intussusception at emergency department.
[Show abstract][Hide abstract] ABSTRACT: Colon perforation is an abdominal surgical emergency in the pediatric population, but is seldom reported when occurring from non-traumatic causes in children beyond the neonate. The goal of this study was to identify the clinical characteristics, management, and outcomes of non-traumatic colon perforation in children. Medical records for the 10-year period from September 1994 to September 2004 were reviewed for children beyond the neonate with non-traumatic colon perforation. Data gathered included age, gender, symptoms, duration of symptoms, physical findings, and length of postoperative hospital stay. Diagnostic information included laboratory data, radiographic imaging, and operative findings. Forty-four patients with non-traumatic colon perforation were recruited into this study. The mean age was 2.22 +/- 1.87 years; 91.4% of cases were younger than 5 years old. The most common presenting symptom was fever (97.7%); the most common sign was abdominal distention (93.1%). The mean duration of symptoms prior to admission was 6.19 days. Pneumoperitoneum was presented in 86.3% of patients by plain abdominal radiograph. Ascending and transverse colon were the most common perforation sites. Non-typhoid salmonella was the leading pathogen isolated, causing 20.4% of episodes. One case died due to Clostridium speticum infection. Non-traumatic colon perforation most commonly affects children younger than 5 years of age. It may be secondary to infection, especially non-typhoid salmonella. Plain abdominal radiograph can be an adjuvant tool for the high index of suspicion for colon perforation in children with abdominal distention and history of fever or diarrhea for more than 5 days.
Pediatric Surgery International 09/2006; 22(8):665-9. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The reduced incidence of graft-vs.-host disease following umbilical cord blood (CB) transplantation may be related to the functional immaturity of newborn T cells expressing mainly the naive CD45RA phenotype. Expansion of CD4(+) CD45RA(+) T cells using cytokines may benefit neonates and infants with human immunodeficiency virus (HIV) infection, as a preferential decline in CD4(+) CD45RA(+) cells has been noted as HIV disease progresses. The aim of the study was to investigate the effect of interleukin (IL)-15, a novel cytokine similar to IL-2 in biological activities, on CD45RA/RO expression and apoptosis in umbilical cord blood (CB) and adult peripheral blood (APB) mononuclear cells (MNCs). Prior to culture, CB MNCs contained a greater number of CD4(+) CD45RA(+) cells and fewer CD4(+) CD45RO(+) cells than did APB MNCs. When incubated with RPMI-1640 containing 10% fetal calf serum for 7 days, the percentage of CD45RA(+) cells within CD4(+) T cells (%CD45RA(+)/CD4(+)) significantly decreased compared to that of fresh CB MNCs. IL-15 exerted a dose-dependent increase of %CD45RA(+)/CD4(+) and a corresponding decrease of %CD45RO(+)/CD4(+) in CB MNCs, an effect not observed with APB MNCs treated with IL-15. The percentages of CD45RA(+) and CD45RO(+) expression within CD8(+) cells, however, were not influenced by IL-15, in either CB or APB MNCs. A greater number of CB MNCs underwent apoptosis than did APB MNCs after 7 days of culture in RPMI-1640 containing 10% fetal calf serum. IL-15 did not inhibit apoptosis but induced proliferation comparable to that achieved in APB MNCs. The ability of IL-15 to preferentially enhance the proliferation of CD4(+) CD45RA(+) cells in CB MNCs suggests a role for immunomodulative therapy in HIV-infected newborns and infants.
Pediatric Allergy and Immunology 09/2001; 12(4):188-93. · 3.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The decreased incidence of graft-vs.-host disease found following umbilical cord blood (CB) transplantation, and the increased susceptibility of newborns to infections, have been attributed, in part, to functional and phenotypic immaturity of neonatal T cells. We investigated the phenotypic changes of CB T cells induced by two immunoregulary cytokines, interleukin (IL)-12 and IL-15, alone or in combination. Adult peripheral blood (APB) mononuclear cells (MNCs) were also tested for comparison. Prior to culture, the percentages of CD3+ CD8+, CD3+ CD25+, and CD3+ CD56+ cells were significantly lower in CB MNCs than in APB MNCs. IL-15, but not IL-12, significantly increased CD3+ CD8+ expression among the CB MNCs after 1 week of culture. Combining IL-12 and IL-15, however, resulted in decreased CB CD3+ CD8+ expression compared with IL-15 alone. The percentage of CD3+ CD25+ cells in CB MNCs spontaneously increased in the absence of cytokines, while that of CD3+ CD56+ cells in CB MNCs could not be enhanced with cytokines. In contrast, the percentages of CD3+ CD25+ and CD3+ CD56+ cells among the APB MNCs could be increased with IL-12, IL-15, and further with IL-12 and IL-15 combined. Thus, different patterns of T-cell subset changes were demonstrated between CB MNCs and APB MNCs in response to IL-12 and/or IL-15. These data may serve as a foundation for using cytokine therapy in newborns and children receiving CB transplants.
Pediatric Allergy and Immunology 03/2001; 12(1):21-6. · 3.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the risk factors for intestinal perforation in children with toxic megacolon caused by non-typhi Salmonella infection.
During an 11-year period we reviewed the records of children treated for non-typhi Salmonella infection. All of the subjects had positive stool culture for non-typhi Salmonella and were treated with intravenous ceftriaxone during hospitalization. Clinical data reviewed included demographic features, clinical manifestations, laboratory findings, radiologic findings, microbiology, therapeutic effect of hydration and rectal tube placement and the operative findings. Patients with toxic megacolon were defined as those having toxic appearance, diarrhea, high fever (>39 degrees C) and marked colon dilatation with maximal diameter > 1.5 times the width of the vertebra body of the first lumbar spine (L1-VB). To define the risk factors for patients with toxic megacolon complicated by intestinal perforation, patients were divided into two groups for analysis: P group, those complicated with intestinal perforation; and NP group, those without intestinal perforation. Differences in age, sex, severity of diarrhea, duration of fever, hemogram and its differential, culture, stool analysis, serum C-reactive protein (CRP), electrolytes, maximal colon diameter, medical therapy and timing of rectal tube insertion between the two groups were analyzed. Statistical analyses were conducted with chi square tests and multiple logistic regression.
A total of 75 patients (P group, 27 patients; NP group, 48 patients) ages 4 months to 6 years were evaluated. With chi square analysis 7 variables were found to be significantly associated with intestinal perforation: age >1 year; fever >5 days; ratio of immature to total neutrophils >20%; serum CRP >200 mg/l; colon diameter >2.5 times the width of L1-VB; inadequate early hydration; and delay in rectal tube insertion. With multivariate analysis age >1 year, serum CRP >200 mg/l and colon diameter >2.5 times of width of L1-VB, inadequate early hydration and delay in rectal tube insertion were the most significant factors associated with intestinal perforation.
Identification of patients with toxic megacolon associated with non-typhi Salmonella infection at risk for further intestinal perforation is possible. Early effective fluid resuscitation and rectal tube insertion may be helpful to prevent the occurrence of intestinal perforation.
[Show abstract][Hide abstract] ABSTRACT: We investigated the diameter of pancreatic duct using ultrasonography in 51 children with pancreatitis and age-matched healthy control children over a 5 year period. The diameters of pancreatic duct and pancreatic body were measured simultaneously by sonography. The mean ages of children with acute pancreatitis and chronic pancreatitis were 9.7 +/- 3.9 and 10.3 +/- 3.1 years, respectively (range, 1 to 8 years). The mean age of normal children was 9.6 +/- 5.3 years. A significant difference was found in diameter of the pancreatic duct between children with acute and chronic pancreatitis versus that of age-matched control. In addition, a significant difference in diameter of the pancreatic body was found between children with acute pancreatitis and age-matched controls, but there was no marked difference in diameter of the pancreatic body between normal persons and those with chronic pancreatitis. The mean diameters of the pancreatic duct in acute pancreatitis and chronic pancreatitis were 2.34 +/- 0.47 mm and 2.84 +/- 0.67 mm, respectively, which was greater than that of normal children (1.65 +/- 0.45 mm). Pancreatic ducts with diameters greater than 1.5 mm in children between 1 and 6 years, greater than 1.9 mm at ages 7 to 12 years, or greater than 2.2 mm at ages 13 to 18 years were significantly associated with the presence of acute pancreatitis. Thirty-two patients, including 25 with acute pancreatitis and 7 with chronic pancreatitis, underwent follow-up measurement of pancreatic duct and serum lipase examination on at least three occasions. A good correlation between the diameter of pancreatic duct and serum lipase level was found. Thus, ultrasonography of the pancreatic duct is valuable in diagnosis and monitoring of pancreatitis in children.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2000; 19(11):757-63. · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Within a 3 year period from July 1996 to July 1999, a total of 105 children with clinical diagnosis of cellulitis were evaluated by ultrasonography. Eighty-six children (age range, 17 days to 15 years) fulfilling the sonographic criteria for diagnosis of cellulitis were enrolled into the study. The sonographic features were used to correlate with clinical symptoms and their duration, the peripheral leukocyte count, and the serum C-reactive protein level. Pus aspiration for immediate microscopic and later bacteriologic studies was carried out under sonographic guidance. Ultrasonographic features of cellulitis included subcutaneous tissue thickening without distortion and pus (25 cases, 29%), distortion of subcutaneous tissue without pus accumulation (26 cases, 30%), distortion of subcutaneous tissue with pus accumulation (19 cases, 23%), and distortion of tissue with abscess formation (16 cases, 18%). The presence of sonographic features of tissue distortion with or without pus accumulation, including abscess formation in children with cellulitis, correlated with a longer duration of symptoms (greater than 4 days), the presence of high-grade fever, higher peripheral leukocyte count, and higher serum C-reactive protein levels. Those patients who underwent sonographically guided aspiration or surgical intervention showed a shorter hospital stay and fever duration than those without such aspiration. Our results indicated that ultrasonography is of great value in managing cellulitis by providing information regarding the progression of inflammation. Sonographically guided aspiration of pus may be a treatment of choice, as it may decrease the need for operation.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2000; 19(11):743-9. · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigated the effect of two immunoregulatory cytokines interleukin-12 (IL-12) and IL-15, alone or in combination, on CD69 expression of mononuclear cells (MNCs) obtained from umbilical cord blood (CB) and adult peripheral blood (APB). We established that (1) CD3/69, but not CD16/69, expression on CB MNCs could be increased with IL-12, IL-15 or both in 18-hour cultures, but to a lesser degree compared to that on corresponding APB MNCs, (2) CD3/69 expression on CB MNCs was significantly increased after 1 week's culture with IL-12, especially with IL-15, exceeding that on APB MNCs similarly activated and (3) CD16/69 expression on CB MNCs, but not APB MNCs, was greatly increased after 1 week's culture with IL-15. The combination of IL-12 + IL-15 resulted in greater CB CD3/69 expression than individual cytokines, while producing less of an effect on CD16/CD69 expression as compared to IL-15 alone. The results of our study indicate that neonatal T and NK cells readily respond to cytokine stimulation by upregulating CD69 expression, with a greater effect achieved using IL-15 compared to IL-12.
Biology of the Neonate 11/2000; 78(3):181-5. · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Expansion and activation of cord blood (CB) natural killer (NK) cells by cytokines might greatly benefit patients undergoing stem cell transplantation by increasing resistance against viral infections and providing graft-vs.-leukemia (GVL) effects through enhanced cytolytic abilities. We tested the ability of a recently cloned stem cell factor, Flt3-ligand (Flt3L), in combination with interleukin-15 (IL-15), to stimulate CB mononuclear cells (MNCs) to proliferate and differentiate into NK cells, in comparison with adult peripheral blood (APB) MNCs. Unstimulated CB MNCs had low NK and lymphokine-activated killer (LAK) activity compared with APB MNCs. A similar dose-dependent increase in NK and LAK activity and CD16/56 expression was found with IL-15 in CB and APB MNCs after 10 days of culture. The NK cytotoxicity (against K562 cells) of IL-15-treated CB MNCs was lower than that of corresponding APB MNCs, while IL-15-induced LAK activity (against Daudi cells) of CB MNCs was comparable to that of corresponding APB MNCs. IL-15 resulted in greater CD16/56 expression in CB MNCs compared with APB MNCs after 10 days of culture. Flt3L, alone or in combination with IL-15, had little effect on CD16/56 expression and cytotoxicity. Cytotoxic activities and CD16/56 expression did not alter after CD34 depletion of CB MNCs. We therefore concluded that CB NK cells could be greatly activated and expanded with IL-15, but not with Flt3L. The greater expression of CD16/56 induced by IL-15 in CB MNCs may originate from non-CD34+ NK progenitor cells.
Pediatric Allergy and Immunology 09/2000; 11(3):168-74. · 3.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This 3 year prospective study evaluated the sensitivity and specificity of abdominal ultrasonography and color Doppler ultrasonography in 31 neonates with suspected malrotation or malrotation with volvulus. Water instillation was used to detect duodenal dilatation, edema, and malrotated bowels. Twenty patients with ultrasonographic characteristics of inversion of the superior mesenteric artery and superior mesenteric vein were later surgically proved to have malrotation. Nine of these 20 patients also had volvulus. Sonographic features suggestive of volvulus included duodenal dilation with tapering configuration (8 of 9 cases, 89%), fixed midline bowel (8 of 9 cases, 89%), whirlpool sign (8 of 9 cases, 89%), and dilation of the distal superior mesenteric vein (5 of 5 cases, 100%). The sensitivity and specificity of duodenal dilation with tapering configuration for detecting volvulus were 89% and 92%, respectively; of fixed midline bowel, 89% and 92%; of whirlpool sign, 89% and 92%; and of dilation of distal superior mesenteric vein, 56% and 73%. The results of this study indicate that ultrasonographic features of inversion of the superior mesenteric artery and superior mesenteric vein could aid in the diagnosis of malrotation, and certain sonographic features can also be used to evaluate volvulus, a condition requiring emergent operation.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 07/2000; 19(6):371-6. · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We reviewed the clinical and laboratory manifestations and analyzed the outcome in children with Henoch-Schönlein purpura (HSP) and gastrointestinal involvement.
The medical records of 158 children who had Henoch-Schönlein purpura with gastrointestinal (GI) involvement admitted to our institution from June 1987 to December 1998 were reviewed. We retrospectively analyzed their demographic features, clinical manifestations, and outcome.
Totally 104 boys and 54 girls (male: female = 1.9:1) were enrolled in this study, with a mean age of diagnosis of 5.8+/-4.8 years (range: 2 to 13 years). Sixty-three (40%) of our patients had preceding upper respiratory tract infection. The main GI manifestations included abdominal pain (88%); GI bleeding (75%), and vomiting (25%). Bowel edema was found in 71% of examined patients. Upper GI endoscopy provided supportive evidence of HSP in 58% of patients examined. Five patients were found to have marked jejunal edema with bowel collapse leading to severe intestinal obstruction. Thirteen patients (8.2%) had emergent complications including massive blood loss from GI tract in 4, seizure in 2, severe hypoalbuminemia in 2, and emergent surgical condition in 6. Twenty-one patients (13%) experienced prolonged hospitalization (> or =10 days). Bilious vomiting, hematemesis, leukocytosis (>20000/cmm), high C-reactive protein (>50 mg/l), and hemorrhagic erosive duodenitis were found to correlate with prolonged hospitalization. Fourteen (20%) of 70 patients who received follow-up for more than 5 years experienced GI recurrence of HSP.
Despite severe and protracted GI symptoms in some HSP patients, the overall prognosis of GI involvement in children with HSP remains good.