• Clinical and Experimental Pediatrics
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• v.48 no.1
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• pp.68-74
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• 2005

Purpose : There is growing use of continuous renal replacement therapy(CRRT) for pediatric patients, but reports about the use and outcome of CRRT in children is rare in Korea. We report our experiences of CRRT in critically ill pediatric patients. Methods : We reviewed the medical records of 23 pediatric patients who underwent CRRT at Asan Medical Center between May 2001 and May 2004. We evaluated underlying diseases, clinical features, treatment courses, CRRT modalities and outcomes. Results : Ages ranged from three days to 16 years with a median of five years. Patients weighed 2.4 to 63.9 kg(median 23.0 kg; 10 patients ${\leq}20kg$). The underlying diseases were malignancy(nine cases), multiple organ dysfunction syndrome(five cases), hyperammonemia(four cases), acute renal failure associated with liver failure(three cases), dilated cardiomyopathy(one case) and congenital nephrotic syndrome(one case). Pediatric Risk of Mortality(PRISM) III score was $17.6{\pm}7.6$ and the mean number of failing organs was $3.0{\pm}1.7$. Duration of CRRT was one to 27 days(median : nine days). Eleven patients(47.8%) survived. Chronic renal failure developed in two cases, intracranial hemorrhage in one case, and chylothorax in one case among the survivors. PRISM III score and the number of vasopressor before the start of CRRT was significantly lower in the survivors($12.7{\pm}4.2$ and $0.9{\pm}1.1$) compared with nonsurvivors($22.1{\pm}7.8$ and $2.4{\pm}1.4$)(P<0.05). Conclusion : CRRT driven in venovenous mode is an effective and safe method of renal support for critically-ill infants and children to control fluid balance and metabolic derangement. Survival is affected by PRISM III score and the number of vasopressors at the initiation of CRRT.

• Clinical and Experimental Pediatrics
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• v.51 no.10
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• pp.1077-1084
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• 2008

Purpose : Despite the seriousness of bacterial meningitis in children, there is little information on the incidence, causative organisms, mortality rate and age distribution. We studied the frequency by age group and causal pathogens, and clinical characteristics in children with bacterial meningitis in the private sector in Korea. Methods : The medical records containing the data on bacterial meningitis patients under 18 years of age confirmed by cerebrospinal fluid (CSF) findings were retrospectively analyzed from September, 1993 to August, 2006 at Ewha Womans University Mokdong Hospital. Results : Eighty-one cases of bacterial meningitis were observed. Overall the most common organism was Streptococcus agalactiae (group B streptococcus, GBS) (30 cases, 37.0%) followed by Haemophilus influenzae (22 cases, 27.2%), Streptococcus pneumoniae (12 cases, 14.8%), Escherichia coli (3 cases, 3.7%), Neisseria meningitidis (1 case, 1.2%) and others (13 cases, 16.0%). In neonates and young infants under 2 months, the most common organism was GBS. In children between 3 months, and 5 years, the most common organism was H. influenzae. S. pneumoniae was the most common organism in children over 5 years of age. Thirty-one patients (38.3%) had complications. Of all ages, the mortality rate of bacterial meningitis markedly decreased compared with the previously reported rate. Conclusion : In neonates, GBS meningitis was most common. The frequency of H. influenzae meningitis decreased after the introduction of H. influenzae type b vaccination. A strategy for the prevention of GBS meningitis in neonates should be established. The influence of the pneumococcal conjugate vaccine on S. pneumoniae meningitis should be studied.

• Pediatric Infection and Vaccine
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• v.22 no.2
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• pp.63-68
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• 2015

Purpose: This study analyzed a small outbreak of measles at a single hospital located in northern Gyeonggi-do in 2013. Methods: We reviewed the medical records of measles patients at The Catholic University of Korea Uijeongbu St. Mary's Hospital from August to October, 2013. Results: Fifteen children were confirmed to have measles by RT-PCR and serum IgM test; 1 neonate, 11 infants, and 3 toddlers. None of the patients had received Measles-Mumps-Rubella vaccination. All patients showed B3 type in viral genotyping. Nine children (60%) had been exposed to measles during treatment for other diseases in the pediatric ward. Incubation period was between 8 and 15 days. Fever started at a median 10 days after exposure and persisted for a median of 8 days. Rash showed at a median 13 days after exposure. Respiratory complications were observed in 40% of patients. Diarrhea developed in 53% of patients. Conclusion: Although measles has been well-controlled due to the high rate of vaccination coverage, it is possible to have an outbreak at any given time, especially in infants. We must learn from this outbreak, and remain fully aware of the possibility of reemergence and provide proper management, including vaccination or immune globulin administration, to infants exposed to measles. Reevaluation of serum IgG titer of neonates, infants, and pregnant women may be the first step to prevent further outbreaks.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.891-899
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• 2006

Background: This study is to evaluate the safety of ATS valve by examining the clinical results of ten-years experience. Material and Method: From July 1995 to March 2005, we reviewed 305 patients with ATS valve implantation. Mean age was $49.8{\pm}11.7$ years and 140(45.6%) males were included. Etiologies were rheumatic diseases in 207 cases(67.4%), degenerative changes in 57 cases(18.6%), valve dysfunction in 23 cases(7.5%) and infective endocarditis in 14 cases(4.6%). AVR was performed in 72 patients(23.5%), MVR in 156 patients (50.8%), DVR(AVR+MVR) in 63 patients(20.5%) and TVR in 16 patients(5.2%). Result: There were 9 operative mortalities(2.9%). Follow up period was $56.5{\pm}34.0(0{\sim}115)$ months and 96.4% patients were followed up with 9 late deaths. Five and ten years survival rates were $94.9{\pm}1.3%,\;91.2{\pm}2.3%$ using Kaplan-Meier's methods. Valve related event free survival rates in 5 and 10 years were $90.8{\pm}2.0%$ and $86.9{\pm}3.2%$. There were 16 anticoagulation-related hemorrhages, 6 thromboembolisms, 3 prosthetic valve endocarditis and 1 paravalvular leakage. NYHA class improved after operation(p<0.05). Postoperative echocardiography showed significant decrease in LA size, LVEDD and IVESD(p<0.01). Patients with 19 and 21 mm valve showed significantly higher transvalvular pressure gradient in aortic position(p<0.001, p<0.001). Conclusion: ATS valve showed good hemodynamic results with few valve related complications and thus can be used with acceptable risk.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.1
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• pp.45-53
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• 2008

Purpose: We are trying to analyze 130 patients' conditions by using our Helical Tomotherapy, which was installed in our center in Oct. 2007. We will be statistically approach this examination and analyze so that we will be able to figure out adaptive plans according to the change in place of the tumor, GTV (gross tumor volume), total amount of time it took, vector (${\upsilon}=\surd$x2+y2+z2) and the change in size of the tumor. Materials and Methods: Objectives were the patients who were medicated with Tomotherapy in our medical center since Oct. 2007 August 2008. The Average age of the patients were 53 years old (Minimum 25 years old, Maximum 83 years old). The parts of the body we operated were could be categorized as Head&neck (n=22), Chest (n=47), Abdomen (n=25), Pelvis (n=11), Bone (n=25). MVCT had acted on 2702 times, and also had acted on our adaptive plan toward patients who showed big difference in the size of tumor. Also, after equalizing our gained MVCT and kv-CT we checked up on the range of possible mistake, using x, y, z, roll and vector. We've also investigated on Set-up, MVCT, average time of operation and target volume. Results: Mean time on table was 22.8 minutes. Mean treatment time was 13.26 minutes. Mean correction (mm) was X=-0.7, Y=-1.4, Z=5.77, roll=0.29, vector=8.66 Head&neck patients had 2.96 mm less vector value in movement than patients of Chest, Abdomen, Bone. In increasing order, Head&neck, Bone, Abdomen, Chest, Pelvis showed the vector value in movement. Also, there were 27 patients for adaptive plan, 39 patients, who had long or multiple tumor. We could know that When medical treatment is one cure plan, it takes 32 minutes, and when medical treatment is two cure plan, it takes 40 minutes that one medical treatment takes 21 minutes, and the other medical treatment takes 19 minutes. Conclusion:With our basic tools, we could bring more accurate IMRT with MVCT. Also, through our daily image, we checked up on the change in tumor so that adaptive plan could work. It was made it possible to take the cure of long or multiple tumor, the cure in a nearby OAR, and the complicated cure that should make changes of gradient dose distribution.

• Journal of Korean Tunnelling and Underground Space Association
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• v.20 no.3
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• pp.543-560
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• 2018

With the increased development in downtown underground space facilities that vertically cross under a railway at a shallow depth, the demand for non-open cut method is increasing. However, most construction sites still adopt the pipe roof method, where medium and large diameter steel pipes are pressed in to form a roof, enabling excavation of the inside space. Among the many factors that influence the loosening region and loads that occur while pressing in steel pipes, the size of the pipe has the largest impact, and this factor may correspond to the magnitude of load applied to the underground structure inside the steel pipe roof. The super equilibrium method (SEM) has been developed to minimize ground disturbance and loosening load, and uses small diameter pipes of approximately 114 mm instead of conventional medium and large diameter pipes. This small diameter steel pipe is called an SEM pile. After SEM piles are pressed in and the grouting reinforcement is constructed, a crossing structure is pressed in by using a hydraulic jack without ground subsidence or heaving. The SEM pile, which plays the role of timbering, is a fore-poling pile of approximately 5 m length that prevents ground collapse and supports surface load during excavation of toe part. The loosening region should be adequately calculated to estimate the spacing and construction length of the piles and stiffness of members. In this paper, we conducted a comparative analysis of calculations of loosening load that occurs during the press-in of SEM pile to obtain an optimal design of SEM. We analyzed the influence of factors in main theoretical and empirical formulas applied for calculating loosening regions, and carried out FEM analysis to see an appropriate loosening load to the SEM pile. In order to estimate the soil loosening caused by actual SEM-pile indentation and excavation, a steel pipe indentation reduction model test was conducted. Soil subsidence and soil loosening were investigated quantitatively according to soil/steel pipe (H/D).

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.2
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• pp.105-112
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• 2014

Purpose: Ultrasound-guided epidural caudal block for low back pain and radiating pain is often performed in the treatment of outpatients. However, this procedure has a failure rate of up to 25% even when it performed by an experienced physician. The authors investigate the effectiveness of Ultrasound-guided epidural caudal block in patients related to disc herniation or spinal stenosis. Materials and Methods: Ultrasound-guided caudal epidural block was performed in 55 outpatients with LBP and radiating pain. Patient was placed in the prone position and sonographic image of sacral hiatus was obtained using linear probe. A 22-gauge needle was advanced into the sacrococcygeal membrane under ultrasound guidance and then medication was injected into the caudal epidural space. There were 31 cases of disc herniation, and 24 cases of spinal stenosis. Patients were evaluated by Visual Analog Scale (VAS) pain score at pre-treatment, post-treatment, 2 weeks and 4 weeks by telephone interviews. Results: 53 of the 55 cases (96.4%) of needle insertion into the sacral canal under ultrasound guidance were successful. Gender was not significantly different between disc herniation group and spinal stenosis group. But there was a significant age difference between disc herniation group ($42.3{\pm}10.8$), and spinal stenosis group ($62.8{\pm}15.1$) [p<0.001]. The VAS score at pre-treatment, post-treatment, 2 weeks, 4 weeks in disc group were 6.84, 3.1, 1.8 & 1.77. The VAS score at pre-treatment, post-treatment, 2 weeks, 4 weeks in spinal stenosis group were 6.88, 3.58, 4.33 & 4.88. The VAS score in both groups was significantly improved after the procedure (p<0.001). Over time, the two groups were statistically significant differences in VAS score after adjusting for age (p<0.001). Conclusion: Ultrasound-guided caudal epidural block seems to provide a high success rate and a significantly better response in disc group than spinal stenosis group.

• Tuberculosis and Respiratory Diseases
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• v.39 no.3
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• pp.248-254
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• 1992

Background: Pleural effusion is one of the most common clinical problems in pulmonology because of high prevalence of pulmonary tuberculosis and bronchogenic carcinoma in Korea. The differential diagnosis between pleural transudate and exudate is very important, but it is very difficult in some cases. Methods: In order to assess the clinical usefulness of cholesterol levels for the differential diagnosis of pleural transudate and exudate, we measured pleural fluid cholesterol levels by enzymatic method in 45 patients who were admitted due to pleural effusion. Results: The mean cholesterol level of transudate was $33.1{\pm}12.9\;mg%$, tuberculous exudate was $97.3{\pm}28.2\;mg%$ and malignant exudate was $97.3{\pm}28.2mg%$. When the cut-off value of pleural cholesterol level was 60 mg%, one case (6.7%) of tuberculous exudate and two cases (13.3%) of malignant exudate were incorrectly classified, but all cases of transudate were classified correctly. When the cut-off value of pleural/serum cholesterol ratio was 0.3, one case (6.7%) of transudate and two cases (13.3%) of malignant exudate were incorrectly classified, but all cases of tuberculous exudate were classified correctly. When the cut-off value of pleural cholesterol level to differentiate pleural transudate from exudate was 60 mg%, sensitivity was 90% and specificity was 100%. When the cut-off value of pleural/serum cholesterol level to differentiate pleural transudate form exuidate was 0.3, sensitivity was 93% and specifiity was 93%. Conclusions: From the above results, it can be concluded that measurement of pleural fluid cholesterol levels is useful for the differential diagnosis between pleural transudate and exudate.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.606-612
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• 2005

Background : It has been reported that nontuberculosis mycobacterium(NTM) isolates account for approximately 10% of patients with a positive Acid-Fast Bacilli(AFB) smear. Therefore, it is necessary to consider NTM pulmonary disease when such a positive test is encountered. The aim of this study was to evaluate the etiologies and clinical characteristics of patients with NTM pulmonary disease who had been treated at a national tuberculosis hospital. Methods : The NTM isolates were recovered from the sputum or bronchial washing specimens submitted to a clinical laboratory of National Masan TB Hospital from August 2002 to July 2003. All samples were identified using a polymerase chain reaction-restriction fragment length polymorphism analysis method, which amplifies the rpoB gene. The patients were diagnosed with NTM disease according to the American Thoracic Society diagnostic criteria. Results : One hundred NTM isolates were recovered from 57 patients. Of the 100 isolates, M. avium complex(MAC) was the most common species, which was found 55%(n=55) of patients, followed by M. abscessus(n=25), and M. fortuitum( n=9). 26(45.6%) patients had NTM disease. Twenty-six (45.6%) patients had NTM disease according to The American Thoracic Society classification. The main organisms involved in NTM disease were MAC(n=19, 73.1%) and M. abscessus(n=5, 19.2%). The pathogenic potential was 67.9% in M. intracellulare and 41.7% in M. abscessus. The predictive factors related to NTM disease were a positive sputum smear (OR 6.4, p=0.02) and the isolation of either MAC or M. abscessus(OR 6.9, p=0.007). Fifteen patients(57.7%) were cured. There were no significant factors associated with the treatment success. Conclusion : There was a relatively high proportion of NTM disease in NTM isolates and the common species were MAC and M. abscessus. The predictive factors for NTM disease were a positive sputum smear and the isolation of either MAC or M. abscessus.

• Journal of Gastric Cancer
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• v.8 no.1
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• pp.40-46
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• 2008

Purpose: We wanted to evaluate the efficacy and toxicity of modified FOLFOX-6 chemotherapy for treating recurrent or inoperable gastric cancer patients. Materials and Methods: From April 2006 to August 2007, 35 patients with recurrent gastric cancer after curative resection and 43 patients with inoperable gastric cancer underwent chemotherapy, and the results were retrospectively investigated. Results: 78 patients were assessable for response and toxicity, and they underwent an average of 7.1 cycles of chemotherapy. The response was evaluated according to the RECIST criteria. 11 partial responses (14.1%), 35 cases of stable disease (44.9%), and 32 cases of progressive disease (41%) were observed. The median time to progression was 6 months, and the average overall survival was 13 months. CTCAE grade 1 or 2 anemia (52.6%) was the most prevalent toxicity. Other common toxicities included thrombocytopenia (17.9%) and peripheral neuropathy (30.8%). There were 13 changes in the chemotherapy regimen to S1-cisplatin due to disease progression, but only an average of 1.76 cycles of S1-cisplatin were delivered due to severe toxicities and poor compliance. Conclusion: Acceptable efficacy and toxicity were seen as 59% of the patients showed non-progression, and no grade 3 or 4 toxicities were observed. In conclusion, the modified FOLFOX-6 chemotherapy is considered to be the proper 1st-line choice as a palliative treatment for recurrent or inoperable gastric cancer patients.