Winnie Yang

Imperforate hymen presenting with chronic constipation and lumbago: report of one case.

A history of unexplained low back pain associated with chronic constipation in an adolescent girl of menarchal age or in an obviously postmenarchal girl should make one consider an imperforate hymen with hematocolpos. This is a particular important differential diagnosis in the work-up of an adolescent who denies ever having had menses or sexual activity. The case of a girl with an imperforate hymen presenting with a six-month history of chronic constipation and intermittent low back pain is described.

Thyroid dysfunction in patients with Down syndrome.

BACKGROUNDnThe close relationship between thyroid disorder and Down syndrome (DS) had been widely reported in the literature. The aim of this study was to assess the prevalence rate and the pattern of thyroid dysfunction in DS in Taiwan.nnnMETHODSnA total of 50 Down syndrome (DS) patients from Yang-Ming Home for Disabled, were recruited. In all patients, serum T3, T4, free T4, TSH, thyroid peroxidase antibody (anti-TPO) and anti-TSH receptor antibody were measured. The control group consisted of 212 healthy adults who underwent routine health examination in this hospital.nnnRESULTSnAmong 50 DS patients, 8 had subclinical hypothyroidism and one had hyperthyroidism. There was no statistically significant in gender and age between DS and control groups, however, TSH anomaly was significantly higher in the DS group (p = 0.008). Regarding thyroid autoantibodies, anti-TPO was positive in 13 cases (26%) and anti-TSH receptor was positive in 2 cases (4%). Statistically, there was no significant difference in TSH anomaly (p = 0.7), positive anti-TPO antibody (p = 0.097) and positive anti-TSH receptor antibody (p = 1.0) between males and females. The increased TSH levels had no statistically positive correlation with anti-TPO (p = 0.386) or anti-TSH receptor antibody (p=1) in this study. The prevalence of thyroid dysfunction was 18% (9/50) in DS patients in Taiwan. Most of them showed subclinical compensated hypothyroidism (16%, 8/50), and one (2%, 1/50) showed hyperthyroidism.nnnCONCLUSIONSnThyroid dysfunction is common in DS patients, so periodic thyroid function tests should be performed and early treatment should be given to prevent further intellectual deterioration and improve overall development.

Vitamin D deficiency rickets due to inappropriate feeding: report of one case.

Vitamin D deficiency rickets is rare among infants and children in the industrialized countries. In this paper, we report a 2-year-5-month-old girl with aching and bowed legs. A food allergy with atopic dermatitis was diagnosed since her early infancy. Strict dietary restrictions were done and she was mostly fed soybean juice and rice foods. Fortified soybean formula (Isomil) was introduced one month before admission. Vitamin D deficiency rickets was diagnosed by a history of inappropriate feeding, roentgenographic and laboratory findings. The therapeutic regimen included 1, 25-dihydroxycholecalciferol 0.5 ug/day and calcium carbonate 100 mg/kg/day. Extensive nutritional counseling was also given for correction of aberrant dietary practices. After a one-year follow-up, there was radiological evidence of bone healing, and marked improvement of leg deformities.

Early-Onset Listeriosis in Prematurity

Listeria monocytogenes has been recognized as a human pathogen for more than 70 years. It causes illness mainly in pregnant women, newborns, elderly, and immunocompromised persons. Although L. Monocytogenes is a relatively uncommon pathogen in neonates, it can cause considerable morbidity and mortality in this age group, especially in the early-onset form of the disease. In Taiwan, neonatal listeriosis is rarely reported. We report one case of a premature newborn with early-onset listeria sepsis and meningitis.

Helicobacter pylori infection in recurrent abdominal pain in children--a prospective study.

A total of 40 children was recruited to assess the role of Helicobacter pylori infection in children with recurrent abdominal pain syndrome. Among 40 children, seven (17.5%) cases were confirmed to have H. pylori infection. All H. pylori-positive patients had active chronic gastritis histologic findings (p < 0.0001); however, the majority of the H. pylori-negative patients had minimal to mild gastritis histologic findings (p = 0.001). Grossly, chronic gastritis picture was present in all children infected with H. pylori and antral nodular gastropathy present in 43%. 71% of H. pylori-positive patients had elevated anti-H. pylori IgG titer; however, 15% in H. pylori-negative patients (p = 0.006). Serum H. pylori assay had a sensitivity of 71% and specificity of 85%; however, sensitivity and specificity of rapid urease test were 86% and 100% respectively. Antral nodularity is a specific, peculiar endoscopic finding of children infected with H. pylori (p = 0.004). Although the present study suggests that H. pylori-related chronic gastritis may play an etiological role in a subgroup of children with RAP syndrome, but the routine screening of H. pylori infection in children with RAP is not recommended, since no compelling data support the significant association between H. pylori infection and RAP syndrome.

Supraventricular tachycardia after fenoterol inhalation: report of two cases.

Supraventricular tachycardia (SVT) following fenoterol inhalation in metered-dose inhaler (MDI) has never been reported. We report two cases of SVT after fenoterol inhalation in MDI. Case one was a 4-year-old boy who had asthma since early childhood. Paroxysmal supraventricular tachycardia (PSVT) was found after fenoterol inhalation (MDI), which returned to normal sinus rhythm following adenosine injection. The other one was a 9-year-old male who also had asthma since early childhood. He suffered from attacks of PSVT four times after fenoterol inhalation within one year. After verapamil injection and vagal maneuvers, PSVT was converted to normal sinus rhythm. There were no other episodes of SVT after discontinuing usage of fenoterol inhalation for 2 years in the follow-up. We report these two cases to remind pediatricians that cardiac arrhythmias should be evaluated following fenoterol inhalation (MDI).

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome with Severe Psychomotor Retardation: Report of One Case

Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare and severe form of neonatal functional bowel obstruction. Affected neonates present with vomiting, an overdistended abdomen, and a huge bladder after birth, and they usually die early in life despite intensive medical and/or surgical management. We report the case of a girl aged 3 years 7 months who had MMIHS with severe psychomotor retardation; autopsy was performed after her death.

Kawasaki disease presenting with lymphadenopathy and gastrointestinal hemorrhage: report of one case.

We report a 5-year-old boy with Kawasaki disease (KD) initially presenting with cervical lymphadenitis and complicated by gastrointestinal hemorrhage before the use of salicylates (aspirin). A previously well and fully immunized 5-year-old Japanese boy presented with a 5-day history of neck mass and fever. Physical examination showed bilateral lymphadenopathy but not nonexudative conjunctivitis, oral cavity changes, skin rash, or extremity changes. He was admitted with a diagnosis of neck lymphadenitis and treated with parenteral antibiotics. Tarry stool was noted on the second day of admission, before the definitive diagnosis of KD was made, and cimetidine was given to treat the gastrointestinal hemorrhage. On the fourth day of admission, he fulfilled the diagnostic criteria for KD (fever for 9 days plus lymphadenopathy, lip fissure, conjunctivitis, and skin rash). He was treated with intravenous immunoglobulin (2 g/kg/day) and aspirin (80 mg/kg/day), and the fever subsided promptly. Massive gastrointestinal bleeding occurred on the ninth day of admission and was treated with whole blood transfusion, after which the vital signs were stable.

Risk Factors for Perinatal Upper Gastrointestinal Bleeding in Full-Term Neonates

Background and Purpose: Perinatal upper gastrointestinal bleeding (UGI bleeding) is rarely reported, it consists of hemorrhagic or ulcerative lesions in the esophagus, stomach or duodenum, and happened perinatally. The aim of this case-control study was to search for risk factors of perinatal UGI bleeding in full-term neonates. Methods: The enrolled criteria in this study were (1) Full-term neonates (2) Evidence of upper gastrointestinal tract bleeding, even only minimal hematemesis (3) Age of onset ≦1 week (4) No evidence of hemorrhagic disease. Upper gastrointestinal bleeding was confirmed by endoscopy in 9 cases. Each patient case was matched with seven control cases, who were well baby born in the same maternal unit, within 5 days before or after the patient cases. Labor course, mode of delivery, gestational age, body weight, Apgar score, amniotic fluid status and integrity of placenta were recorded. Results: There was no significant difference in gestational age, gender, Apgar score, birth weight, mode of delivery or meconium stain of amniotic fluid between case group and control group. Multivariate logistic regression showed that acute fetal distress (Odds ratio (OR)=18.33. p=0.00389) and protraction disorder (OR=33.0, p=0.005) were significant risk factors associated with perinatal UGI bleeding. On the contrary, breast feeding either exclusive or partial for the initial 3 days after birth had protective effect against upper gastrointestinal bleeding. Conclusion: In conclusion, acute fetal distress and protraction disorder were two significant risk factors and breast feeding either exclusive or partial for the initial 3 days after birth may have protective effect for gastric mucosa. Maternal antacid drug usage during the last month of pregnancy is not a risk factor in this study.

Pediatric eosinophilic gastroenteritis: report of one case.

Eosinophilic gastroenteritis is an uncommon disease of unknown cause found particularly in children. It is characterized by the infiltration of eosinophils into the wall of the gastrointestinal tract, peripheral eosinophilia, and chronic relapsing gastrointestinal disorder. This report describes a patient with serosal eosinophilic gastroenteritis presenting ascites and peripheral eosinophilia. The diagnosis of the eosinophilic gastroenteritis was supported by sonographic analysis and dramatic clinical response to prednisolone therapy.