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Non-Surgical Management of Gastroduodenal Fistula Caused by Ingested Neodymium Magnets
Phen, Claudia,Wilsey, Alexander,Swan, Emily,Falconer, Victoria,Summers, Lisa,Wilsey, Michael The Korean Society of Pediatric Gastroenterology 2018 Pediatric gastroenterology, hepatology & nutrition Vol.21 No.4
Foreign body ingestions pose a significant health risk in children. Neodymium magnets are high-powered, rare-earth magnets that is a serious issue in the pediatric population due to their strong magnetic force and high rate of complications. When multiple magnets are ingested, there is potential for morbidity and mortality, including gastrointestinal fistula formation, obstruction, bleeding, perforation, and death. Many cases require surgical intervention for removal of the magnets and management of subsequent complications. However, we report a case of multiple magnet ingestion in a 19-month-old child complicated by gastroduodenal fistula that was successfully treated by endoscopic removal and supportive care avoiding the need for surgical intervention. At two-week follow-up, the child was asymptomatic and upper gastrointestinal series obtained six months later demonstrated resolution of the fistula.
Non-Surgical Management of Gastroduodenal Fistula Caused by Ingested Neodymium Magnets
Claudia Phen,Alexander Wilsey,Emily Swan,Victoria Falconer,Lisa Summers,Michael Wilsey 대한소아소화기영양학회 2018 Pediatric gastroenterology, hepatology & nutrition Vol.21 No.4
Foreign body ingestions pose a significant health risk in children. Neodymium magnets are high-powered, rare-earth magnets that is a serious issue in the pediatric population due to their strong magnetic force and high rate of complications. When multiple magnets are ingested, there is potential for morbidity and mortality, including gastrointestinal fistula formation, obstruction, bleeding, perforation, and death. Many cases require surgical intervention for removal of the magnets and management of subsequent complications. However, we report a case of multiple magnet ingestion in a 19-month-old child complicated by gastroduodenal fistula that was successfully treated by endoscopic removal and supportive care avoiding the need for surgical intervention. At two-week follow-up, the child was asymptomatic and upper gastrointestinal series obtained six months later demonstrated resolution of the fistula.
윤승환,변진수,홍순기,김헌주,한용표,양재승,조미연 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.8
Granulocytic sarcoma, a rare extramedullary solid tumor arising from early myeloid precursors, is capable of invading the meninges or the brain parenchyma. The tumor may occur during or after the onset of systemic myelogenous leukemia. On rare occasions, the tumor may evolve before the onset of systemic myelogenous leukemia. Children are affected more often than adults, but sex is not related. Although no definite target area of the brain can be demonstrated, there may be some predilection of the tumor for the posterior fossa. The authors report a case of 4-year-old-boy with granulocytic sarcoma occuring in the posterior fossa presenting with gait disturbance and torticollis. The patient was treated by surgical removal of the tumor, thereby avoiding the potentially lethal complication of a posterior fassa mass. This rare case is reported together a review of the literature.
Cholestasis beyond the Neonatal and Infancy Periods
Khalaf, Racha,Phen, Claudia,Karjoo, Sara,Wilsey, Michael The Korean Society of Pediatric Gastroenterology 2016 Pediatric gastroenterology, hepatology & nutrition Vol.19 No.1
Cholestasis results from impairment in the excretion of bile, which may be due to mechanical obstruction of bile flow or impairment of excretion of bile components into the bile canaliculus. When present, cholestasis warrants prompt diagnosis and treatment. The differential diagnosis of cholestasis beyond the neonatal period is broad and includes congenital and acquired etiologies. It is imperative that the clinician differentiates between intrahepatic and extrahepatic origin of cholestasis. Treatment may be supportive or curative and depends on the etiology. Recent literature shows that optimal nutritional and medical support also plays an integral role in the management of pediatric patients with chronic cholestasis. This review will provide a broad overview of the pathophysiology, diagnostic approach, and management of cholestasis beyond the neonatal and infancy periods.
Kidder, Molly,Phen, Claudia,Brown, Jerry,Kimsey, Kathryn,Oshrine, Benjamin,Ghazarian, Sharon,Mateus, Jazmine,Amankwah, Ernest,Wilsey, Michael The Korean Society of Pediatric Gastroenterology 2021 Pediatric gastroenterology, hepatology & nutrition Vol.24 No.6
Purpose: Malnutrition is a significant issue for pediatric patients with cancer. We sought to evaluate the effectiveness and complication rate of percutaneous endoscopic gastrostomy (PEG) placement in pediatric oncology patients. Methods: A retrospective chart review was performed on 49 pediatric oncology patients undergoing PEG placement at Johns Hopkins All Children's Hospital between 2000 and 2016. Demographic and clinical characteristics, complications, absolute neutrophil count at time of PEG placement and at time of complications, length of stay, and mortality were identified. Weight-for-age Z-scores were evaluated at time of- and six months post-PEG placement. Results: The overall mean weight-for-age Z-score improved by 0.73 (p<0.0001) from pre- (-1.11) to post- (-0.38) PEG placement. Improvement in Z-score was seen in patients who were malnourished at time of PEG placement (1.14, p<0.0001), but not in those who were not malnourished (0.32, p=0.197). Site infections were seen in 12 (24%), buried bumper syndrome in five (10%), and tube dislodgement in one (2%) patient. One patient (2%) with fever was treated for possible peritonitis. There were no cases of other major complications, including gastric perforation, gastrocolic fistula, clinically significant bleeding, or PEG-related death documented. Conclusion: Consistent with previous studies, our data suggests a relationship between site complications (superficial wound infection, buried bumper syndrome) and neutropenia. Additionally, PEG placement appears to be an effective modality for improving nutritional status in malnourished pediatric oncology patients. However, larger prospective studies with appropriate controls and adjustment for potential confounders are warranted to confirm these findings.
Cholestasis beyond the Neonatal and Infancy Periods
Racha Khalaf,Claudia Phen,Sara Karjoo,Michael Wilsey 대한소아소화기영양학회 2016 Pediatric gastroenterology, hepatology & nutrition Vol.19 No.1
Cholestasis results from impairment in the excretion of bile, which may be due to mechanical obstruction of bile flow or impairment of excretion of bile components into the bile canaliculus. When present, cholestasis warrants prompt diagnosis and treatment. The differential diagnosis of cholestasis beyond the neonatal period is broad and includes congenital and acquired etiologies. It is imperative that the clinician differentiates between intrahepatic and extra-hepatic origin of cholestasis. Treatment may be supportive or curative and depends on the etiology. Recent literature shows that optimal nutritional and medical support also plays an integral role in the management of pediatric patients with chronic cholestasis. This review will provide a broad overview of the pathophysiology, diagnostic approach, and management of cholestasis beyond the neonatal and infancy periods.
Endoscopic Balloon Dilation for Treatment of Congenital AntralWeb
Jacquelin Peck,Racha Khalaf,Ryan Marth,Claudia Phen,Roberto Sosa,Francisco Balsells Cordero,Michael Wilsey 대한소아소화기영양학회 2018 Pediatric gastroenterology, hepatology & nutrition Vol.21 No.4
Congenital antral webs are a rare but relevant cause of gastric outlet obstruction in infants and children. The condition may lead to feeding refusal, vomiting, and poor growth. Due to the relative rarity of the disease, cases of congenital antral web are frequently misdiagnosed or diagnosed with significant delay as physicians favorably pursue diagnoses of pyloric stenosis and gastric ulcer disease, which are more prevalent. We report a case of an eight-month-old female who presented with persistent non-bilious emesis, feeding difficulties, and failure to thrive and was discovered to have an antral web. The web was successfully treated with endoscopic balloon dilation, which resolved her symptoms. Two years later, the patient remains asymptomatic and is thriving with weight at the 75th percentile for her age.
Gastric Xanthoma in the Pediatric Population: A Possible Herald for Malignancy?
Joseph D. Russell,Jacquelin Peck,Claudia Phen,Janna L. Linehan,Sara Karjoo,Johnny Nguyen,Michael J. Wilsey 대한소아소화기영양학회 2020 Pediatric gastroenterology, hepatology & nutrition Vol.23 No.1
Gastric xanthoma is frequently an incidental finding on upper endoscopy in adults. Gastric xanthomas (GX) can be mistaken for malignancies and warrant prompt histologic diagnosis. The underlying etiology is not fully understood; however, it has been linked to Helicobacter pylori gastritis and gastric cancer. GX in the pediatric population is largely unreported in the literature. Because of the relative rarity, documentation with case reports are essential to provide as much data as possible to see if there is a correlation between GX and malignant potential in the pediatric population. Our group is reporting two cases, a 10-year-old male and a 7-year-old male, both who presented with chronic dysphagia, upper abdominal pain, nausea, vomiting, and loss of appetite. Upper endoscopies for both patients revealed small polypoid lesions located in the antrum with foamy histiocytes on histology, leading to the diagnosis of gastric xanthoma.
Endoscopic Balloon Dilation for Treatment of Congenital Antral Web
Peck, Jacquelin,Khalaf, Racha,Marth, Ryan,Phen, Claudia,Sosa, Roberto,Cordero, Francisco Balsells,Wilsey, Michael The Korean Society of Pediatric Gastroenterology 2018 Pediatric gastroenterology, hepatology & nutrition Vol.21 No.4
Congenital antral webs are a rare but relevant cause of gastric outlet obstruction in infants and children. The condition may lead to feeding refusal, vomiting, and poor growth. Due to the relative rarity of the disease, cases of congenital antral web are frequently misdiagnosed or diagnosed with significant delay as physicians favorably pursue diagnoses of pyloric stenosis and gastric ulcer disease, which are more prevalent. We report a case of an eight-month-old female who presented with persistent non-bilious emesis, feeding difficulties, and failure to thrive and was discovered to have an antral web. The web was successfully treated with endoscopic balloon dilation, which resolved her symptoms. Two years later, the patient remains asymptomatic and is thriving with weight at the 75th percentile for her age.
Gastric Xanthoma in the Pediatric Population: A Possible Herald for Malignancy?
Russell, Joseph D.,Peck, Jacquelin,Phen, Claudia,Linehan, Janna L.,Karjoo, Sara,Nguyen, Johnny,Wilsey, Michael J. The Korean Society of Pediatric Gastroenterology 2020 Pediatric gastroenterology, hepatology & nutrition Vol.23 No.1
Gastric xanthoma is frequently an incidental finding on upper endoscopy in adults. Gastric xanthomas (GX) can be mistaken for malignancies and warrant prompt histologic diagnosis. The underlying etiology is not fully understood; however, it has been linked to Helicobacter pylori gastritis and gastric cancer. GX in the pediatric population is largely unreported in the literature. Because of the relative rarity, documentation with case reports are essential to provide as much data as possible to see if there is a correlation between GX and malignant potential in the pediatric population. Our group is reporting two cases, a 10-year-old male and a 7-year-old male, both who presented with chronic dysphagia, upper abdominal pain, nausea, vomiting, and loss of appetite. Upper endoscopies for both patients revealed small polypoid lesions located in the antrum with foamy histiocytes on histology, leading to the diagnosis of gastric xanthoma.