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Effect of Repetitive Transcranial Magnetic Stimulation in Drug Resistant Depressed Patients (치료 저항성 우울증 환자에서 반복적 경두개 자기자극후 국소뇌혈류 변화)

  • Chung, Yong-An;Yoo, Ie-Ryung;Kang, Bong-Joo;Chae, Jeong-Ho;Lee, Hye-Won;Moon, Hyun-Jin;Kim, Sung-Hoon;Sohn, Hyung-Sun;Chung, Soo-Kyo
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.1
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    • pp.9-15
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    • 2007
  • Purpose: Repetitive transcranial magnetic stimulation (rTMS) has recently been clinically applied in the treatment of drug resistant depressed patients. There are mixed findings about the efficacy of rTMS on depression. Furthermore, the influence of rTMS on the physiology of the brain is not clear. We prospectively evaluated changes of regional cerebral blood flow (rCBF) between pre- and post-rTMS treatment in patients with drug resistant depression. Materials and Methods: Twelve patients with drug-resistant depression (7 male, 5 female; age range: $19{\sim}52$ years; mean age: $29.3{\pm}9.3$ years) were given rTMS on right prefrontal lobe with low frequency (1 Hz) and on left prefrontal lobe with high frequency (20 Hz), with 20-minute-duration each day for 3 weeks. Tc-99m ECD brain perfusion SPECT was obtained before and after rTMS treatment. The changes of cerebral perfusion were analyzed using statistical parametric mapping (SPM; t=3.14, uncorrected p<0.01, voxel=100). Results: Following areas showed significant increase in rCBF after 3 weeks rTMS treatment: the cingulate gyrus, fusiform gyrus of right temporal lobe, precuneus, and left lateral globus pallidus. Significant decrement was noted in: the precental and middle frontal gyrus of right frontal lobe, and fusiform gyrus of left occipital lobe. Conclusion: Low-frequency rTMS on the right prefrontal cortex and high-frequency rTMS on the left prefrontal cortex for 3 weeks as an add-on regimen have increased and decreased rCBF in the specific brain regions in drug-resistant depressed patients. Further analyses correlating clinical characteristics and treatment paradigm with functional imaging data may be helpful in clarifying the pathophysiology of drug-resistant depressed patients.

Clinical Characteristics of Arthrogryposis, Renal Tubular Dysfunction, Cholestasis(ARC) Syndrome in Korea (ARC(Arthrogryposis, Renal Tubular Dysfunction, Cholestasis) 증후군의 발병양상에 관한 연구)

  • Lee Soon Min;Kim Ji Hong;Lee Jae Seung;Han Suk Joo
    • Childhood Kidney Diseases
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    • v.9 no.2
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    • pp.222-230
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    • 2005
  • Purpose : ARC syndrome refers to an association of arthrogryposis, renal tubular dysfunction, and cholestasis. The VPS33B gene was recently identified as the causative gene. So far, 41 cases of ARC syndrome have been reported worldwide, and it has rarely been reported in Korea. This study was conducted to report the clinical findings of seven ARC syndrome cases in Korean children, focusing especially on renal tubular dysfunction. Methods : The hospital records of 7 cases diagnosed as ARC syndrome at Severance Hospital between Mar. 1995 and Aug. 2005 were reviewed and analyzed. Results : Of the 7 cases, 4 were boys and 3 were girls. Six patients(85$\%$) were born with normal birth weight at term, and one was born at preterm. All cases presented with cholestasis and severe jaundice. According to the type of arthrogryposis described by Brown et al, type 3 and 4 were found in 2 patients and type,6, 7, and the undistributed type in one patient respectively. Other associated clinical findings were as follows : failure to thrive in 6(85$\%$), lax skin in 5(71$\%$), and gray platelet syndrome in 4(57$\%$). Urine analysis revealed 6 cases(85$\%$) with proteinuria, 3(43$\%$) with hematuria, 5(71$\%$) with glycosuria, 2(29$\%$) with phosphaturia and 2(29$\%$) with calciuria. Serum electrolytes showed 4 cases(57$\%$) with hyponatremia, 3(43$\%$) with hypokalemia, and 1(14$\%$) with creatinine elevation. Renal tubular dysfunctions were diagnosed as renal tubular acidosis in 6 cases(85$\%$), nephrogenic diabetes insipidus in 2(29$\%$), and Fanconi syndrome in 2(29$\%$). During the follow-up period, 2(29$\%$) had no treatment, 5(85$\%$) had continuous supplementation to correct the electrolyte imbalance and acidosis, and 1(14$\%$) had dialysis. Only one patient had a family history of ARE syndrome in a sibling. Four cases(57$\%$) were diagnosed at the mean age of 8.2 months, and one case was lost during follow-up. Ages of the survived 2 cases were 13 and 25 months, respectively. Conclusion : The rare disease of ARC syndrome Is associated with severe renal dysfunction. However, this study revealed that the renal manifestation of ARC syndrome in Korean children is relatively mild and survival rate is higher than that of previous studies. Contrary to previous reports, this study showed that familial cases are rare and sporadic occurence is possible in Korea. Thus, the diagnosis of this syndrome requires a careful evaluation of the venal function in cases of congenital arthrogryposis, and a mandatory genetic counseling of affected family for prevention of familial occurance. (J Korean Soc Pediatr Nephrol 2005;9:222-230)

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Interleukin 1 Receptor Antagonist(IL-1ra) Gene Polymorphism in Children with Henoch-$Sch{\ddot{o}}nlein$ Purpura Nephritis (Henoch-$Sch{\ddot{o}}nlein$ Purpura 신염에서 Interleukin 1 Receptor Antagonist(IL-1ra) 유전자 다형성)

  • Hwang, Phil-Kyung;Lee, Jeong-Nye;Chung, Woo-Yeong
    • Childhood Kidney Diseases
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    • v.9 no.2
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    • pp.175-182
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    • 2005
  • Purpose : Interleukin 1 receptor antagonist(IL-1ra) is an endogenous antiinflammatory agent that binds to IL-1 receptor and thus competitively inhibits the binding of IL-1$\alpha$ and IL-1$\beta$. Allele 2 in association with various autoimmune diseases has been reported. In order to evaluate the influence of IL-1ra gene VNTR polymorphism on the susceptibility to HSP and its possible association with disease severity, manifested by severe renal involvement and renal sequelae, we studied the incidence of carriage rate and allele frequency of the 2 repeats of IL-1ra allele 2($IL1RN^{*}2$) of the IL-1ra gene in children with HSP with and without renal involvement. Methods : The IL-1ra gene polymorphisms were determined in children with HSP with(n=40) or without nephritis(n=34) who had been diagnosed at Busan Paik Hospital and the control groups(n=163). Gene polymorphism was identified by PCR amplification of the genomic DNA. Results : The allelic frequency and carriage rate of $IL1RN^{*}1$ were found most frequently in patients with HSP and in controls. The allelic frequency of $IL1RN^{*}2$ was higher in patients with HSP compared to that of controls($4.7\%\;vs.\;2.5\%$, P=0.794). The carriage rate of $IL1RN^{*}2$ was higher In patients with HSP compared to that of controls($8.1\%\;vs.\;6.8\%$, P=0.916). The allelic frequency of $IL1RN^{*}2$ was higher in patients with HSP nephritis compared to that of HSP($5.3\%\;vs.\;2.9\%$, P=0.356). The carriage rate of $IL1RN^{*}2$ was higher in Patients with HSP nephritis compared to that of HSP($10.0\%\;vs.\;5.9\%$, P=0.523). Among 13 patients with heavy proteinuria(>1.0 g), 11 had $IL1RN^{*}1$, 1 had $IL1RN^{*}2$ and the others had $IL1RN^{*}4$. At the time of last follow up 4 patients had sustained proteinuria and their genotype was $IL1RN^{*}1$. Conclusion : The allelic frequency and carriage rate of $IL1RN^{*}1$ were found most frequently in patients with HSP and in controls. Our study suggests that the carriage rate and allele frequency of the 2-repeats of IL-1lra allele 2($IL1RN^{*}2$) of the IL-1ra gene may not be associated with susceptibility and severity of renal involvement in children with HSP (J Korean Soc Pediatr Nephrol 2005;9:175-182)

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Study on Spring Cocoon Crops with the Leaf Produced in the Mulberry Field close to the Totacco Field (개량 Mulching 담배밭 부근뽕잎이 춘잠작에 미치는 영향에 관한 연구)

  • 이상풍;김정배;김계명;박광준
    • Journal of Sericultural and Entomological Science
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    • v.16 no.1
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    • pp.67-75
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    • 1974
  • The studies are to know how much cocoon crops is damaged by the stained leaf with nicotine produced from the tobacco field cultivated in mulching system in spring season and by residual nicotine in autumn season. Furthermore, the new knowledges are to make both industries keep up with their development. In spring season mulberry Held is located higher on the West-North of tobacco held below 20 degrees of slope and with 36 per cent of East-South wind and 18 per cent of South wind blowing from tobacco fold to the mulberry fold. In addition, silkworm larvae are fed with the mulberry leaf produced in the different plots placing by the different distances, l0m, 25m, 50m, 80m, and loom far from the tobacco Held as a control and it is also considered that narcotic larvae including the dead larvae are not observed. On the other hand, it is noted that better leaf quality and abundant growth of mulberry tree is produced from the mulberry fold closer to the tobacco field and with a low slope. 1) Maximum weight of larval body at the 5th stage is damaged by the stained leaf with the nicotine up to 25m far from the tobacco held. 2) The larvae fed with the mulberry leaf in mulberry Held up to 25m far from the tobacco fold produce small number of the fresh cocoons per 1 liter. 3) Low single cocoon weight and low cocoon shell weight are produced by the poison damaged larvae fed with the mulberry. leaf up to 25m far from the tobacco field and weight of cocoon shell is damaged higher than the single cocoon weight. It is resulted in low percentage of cocoon shell. 4) Cocoon yield including the double cocoon from 10,000 larvae is decreased by the larvae fed with the stained leaf in the mulberry fold up to 25m far from the tobacco fold and 19 per cent of cocoon yield is decreased with 2.4kg of cocoon yield in l0m plot and with 2.5kg of cocoon yield in 25m plot at the first season and at the 2nd season with 1.8kg o( cocoon yield in l0m plot and with 11.5kg of cocoon yield in 25m plot, 11 per cent and 9 per cent of cocoon yield including double cocoon from 10,000 larvae is decreased, as compared with the control, respectively. With these results, it is observed that nicotine damage is occurred to the silkworm larvae if the larvae are fed with the leaf in the mulberry Held within 25m-50m far from the tobacco field.

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Effects of Natural Honeybee (Apis mellifera ligustica) Venom Treatment on the Humoral Immune Response in Pigs (Beevenom 처리가 돼지의 체내 면역반응에 미치는 효과)

  • 조성구;김경수;이석천
    • Journal of Animal Science and Technology
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    • v.48 no.6
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    • pp.933-942
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    • 2006
  • This experiment was carried out to investigate effects of honeybee venom treatment on the humoral immune response in pigs. Corresponding author : S. K. Cho, Dept. of Animal Sci. Chung-Buk National University, Kaesin-dong, Cheongju, 361-763, Korea. phone : 043-261-2551. E-mail : deercho@chungbuk.ac.kr To investigate effects of natural honeybee venom on the concentration of immunoglobulin G, A, and M, 20 piglets(LY×D) from 3 sows were allocated into two groups bee venom-treated group(10 piglets) and non-treated control(10 piglets). Natural honeybee venom was treated at 0, 3, 6 days after birth and the acupoints were Hai-men(ST-25), Du-kou(CV-8) and Jiao-chao(GV-1) points at 0, 3 days after birth and the regions of castration and tail amputation point at 6 days. Control group was injected 1㎖ of saline to the same site. Concentrations of IgG, A, and M were measured with immunoturbidimetric method at 0, 3, 7, 14, and 21 days after treatment. To investigate the effect of bee venom on the production of antibodies against hog cholera and atrophic rhinitis vaccines that were used as indicator antigens, 40 piglets(LYxD) from 5 sows were grouped as bee venom-treated group (20 piglets) and control group(20 piglets). Natural honeybee venom was treated at 0, 3days(castration, tail amputation) and 21days after birth. The acupoints were Hai-men(ST-25), Du-kou(CV-8) and Jiao-chao (GV-1) points at 0 day, the regions of castration and tail ampution at 3 days and Jiao-chao(GV-1) and Bai-hui(GV-20) points at 21days after birth(weaning). Control group was injected 1ml of saline to the same site. Atrophic rhinitis vaccine was injected twice at 24 and 44 days after birth and hog cholera vaccine was also injected twice at 44 and 64 days after birth. Antibody titers against Bordetella bronchiseptica and hog cholera virus were measured by using tube agglutination and ELISA tests at 24, 34, 44, 54 and 74 days after birth. Concentrations of IgG of treated group were 339.52, 366.48, 296.52, 242.06 and 219.06mg/dl at 0, 3, 7, 14 and 21 days after birth, respectively. In contrast, concentrations of IgG in control group were respectively 347.10, 334.14, 243.28, 205.18 and 191.58mg/dl during same periods with treated group. Concentrations of IgG at 0 day was not significantly different between the treated group and control group but treated group were significantly increased by 10.28% at 3 days after birth (P<0.02), 21.88% at 7 days after birth(P<0.01), 18.0% at 14 days after birth(P<0.07) and 14.3% at 21 days after birth(P<0.01). Concentrations of IgA and Ig M were not significantly different. Antibody titers against hog cholera virus were significantly increased by 57.0% at 24 days after birth(P<0.03), 74.6% at 34 days after birth (P<0.006), 48.6% at 44 days after birth(P<0.017), 45.0% at 54 days after birth(P<0.16) and 44.4% at 74 days after birth (P<0.006) in bee venom treated group in comparison with control group. Antibody titers against the Bordetella bronchiseptica was significantly increased in Beevenom treated group as 9.1% (P<0.32) at 24days, 39.7% (P<0.002) at 34days, 31.9% (P<0.02) at 44days, 33.4% (P<0.01) at 54days and 57.3% (P<0.007) at 74 days after birth when compared with those of control group pigs. Collecting together, the results in this study showed that immune responses were increased by treatment of natural honeybee venom to pigs. These results suggested that the treatment of bee venom could be used effectively for the increase of productivity in livestock industry.

Evaluation of the Usefulness of Restricted Respiratory Period at the Time of Radiotherapy for Non-Small Cell Lung Cancer Patient (비소세포성 폐암 환자의 방사선 치료 시 제한 호흡 주기의 유용성 평가)

  • Park, So-Yeon;Ahn, Jong-Ho;Suh, Jung-Min;Kim, Yung-Il;Kim, Jin-Man;Choi, Byung-Ki;Pyo, Hong-Ryul;Song, Ki-Won
    • The Journal of Korean Society for Radiation Therapy
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    • v.24 no.2
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    • pp.123-135
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    • 2012
  • Purpose: It is essential to minimize the movement of tumor due to respiratory movement at the time of respiration controlled radiotherapy of non-small cell lung cancer patient. Accordingly, this Study aims to evaluate the usefulness of restricted respiratory period by comparing and analyzing the treatment plans that apply free and restricted respiration period respectively. Materials and Methods: After having conducted training on 9 non-small cell lung cancer patients (tumor n=10) from April to December 2011 by using 'signal monitored-breathing (guided- breathing)' method for the 'free respiratory period' measured on the basis of the regular respiratory period of the patents and 'restricted respiratory period' that was intentionally reduced, total of 10 CT images for each of the respiration phases were acquired by carrying out 4D CT for treatment planning purpose by using RPM and 4-dimensional computed tomography simulator. Visual gross tumor volume (GTV) and internal target volume (ITV) that each of the observer 1 and observer 2 has set were measured and compared on the CT image of each respiratory interval. Moreover, the amplitude of movement of tumor was measured by measuring the center of mass (COM) at the phase of 0% which is the end-inspiration (EI) and at the phase of 50% which is the end-exhalation (EE). In addition, both observers established treatment plan that applied the 2 respiratory periods, and mean dose to normal lung (MDTNL) was compared and analyzed through dose-volume histogram (DVH). Moreover, normal tissue complication probability (NTCP) of the normal lung volume was compared by using dose-volume histogram analysis program (DVH analyzer v.1) and statistical analysis was performed in order to carry out quantitative evaluation of the measured data. Results: As the result of the analysis of the treatment plan that applied the 'restricted respiratory period' of the observer 1 and observer 2, there was reduction rate of 38.75% in the 3-dimensional direction movement of the tumor in comparison to the 'free respiratory period' in the case of the observer 1, while there reduction rate was 41.10% in the case of the observer 2. The results of measurement and comparison of the volumes, GTV and ITV, there was reduction rate of $14.96{\pm}9.44%$ for observer 1 and $19.86{\pm}10.62%$ for observer 2 in the case of GTV, while there was reduction rate of $8.91{\pm}5.91%$ for observer 1 and $15.52{\pm}9.01%$ for observer 2 in the case of ITV. The results of analysis and comparison of MDTNL and NTCP illustrated the reduction rate of MDTNL $3.98{\pm}5.62%$ for observer 1 and $7.62{\pm}10.29%$ for observer 2 in the case of MDTNL, while there was reduction rate of $21.70{\pm}28.27%$ for observer 1 and $37.83{\pm}49.93%$ for observer 2 in the case of NTCP. In addition, the results of analysis of correlation between the resultant values of the 2 observers, while there was significant difference between the observers for the 'free respiratory period', there was no significantly different reduction rates between the observers for 'restricted respiratory period. Conclusion: It was possible to verify the usefulness and appropriateness of 'restricted respiratory period' at the time of respiration controlled radiotherapy on non-small cell lung cancer patient as the treatment plan that applied 'restricted respiratory period' illustrated relative reduction in the evaluation factors in comparison to the 'free respiratory period.

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Seeding Rate and Planting Date Effects on Forage Performance and Quality of Winter Rye (호밀의 사초특성, 수량 및 품질에 미치는 파종량 및 파종기의 영향)

  • Park, H.S.;Kim, D.A.;Kim, J.D.
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.19 no.2
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    • pp.105-114
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    • 1999
  • This experiment was carried out to determine seeding rate and planting date effects on the forage performance and quality of winter rye(Secale cereale L.) at Suweon in 1997 and 1998. The experiment was arranged in a spilt plot design with three replications. Main plots consisted of three seeding rates; 100, 150, and 200kg/ha. Sub-plots consisted of four planting dates; 5 September, 20 September, 5 October and 20 October. The first heading date of rye was not strongly influenced by planting dates. On a day basis, a 1:15 ratio was existed between heading and planting dates of rye, as a 1-day delay in spring heading date for each 15-day delay in fall planting date. Dry matter content of rye for a seeding rate of 200kg/ha was the lowest of 13.6%, and that for the planting dates was decreased to 15.2, 14.2, 14.3, and 13.8% with delayed seeding (P<0.05). There was an interaction between seeding rate and planting date in dry matter content of rye(P<0.01). Acid detergent fiber (ADF) percentage of rye for the seeding rates was not significant and that for the planting dates was decreased to 32.1, 31.6, 31.6, and 29.3%, as the planting was delayed(P<0.05). There was an interaction between seeding rate and planting date for ADF. Effect of seeding rate and planting date on neutral detergent fiber(NDF) of rye was similar to the observations made on ADF. Crude protein content of rye for the seeding rates was not significant, but that for the planting dates was increased to 17.3, 17.7, 18.2, and 18.9%, as the planting was delayed(P<0.05). In vitro dry matter digestibility(IVDMD) of rye for the seeding rates was not significant, but that for the planting dates was increased to 77.5, 80.6, 80.9, and 80.9%, as the planting was delayed(P<0.05). Dry matter yield of rye for a seeding rate of 100 kg/ha was the highest of 9,059 kg/ha, and that for a seeding rate of 200 kg/ha was the lowest of 7,647 kg/ha(P<0.01). In this experiment, the highest forage yield(8,945 kg/ha) was obtained when planting was completed by early October(5 October), with yield decreased as planting was delayed until 20 October (7,249 kg/ha)(P<0.01). This trend was also observed for the crude protein(CP) and in vitro digestible dry matter(IVDDM) yields of rye. A significant interaction between seeding rate and planting date for the dry matter yield was occurred(P<0.01). Based on the results of this experiment, it appears that the forage dry matter yield of rye could be enhanced by sowing from 20 September to 5 October under upland condition in the middle plain area of Korea. The seeding rates from 100 to 150 kg/ha and that of 200 kg/ha would be suitable for the early-fall and late fall sowing, respectively.

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Hepatitis Complicated with Mycoplasma pneumoniae Infection in Children (소아의 Mycoplasma pneumoniae 폐렴에 합병된 간염)

  • Lee, Seung Min;Lee, Sung Moon;Tchah, Hann;Jeon, In Sang;Ryoo, Eell;Cho, Kang Ho;Seon, Yong Han;Son, Dong Woo;Hong, Hee Joo
    • Clinical and Experimental Pediatrics
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    • v.48 no.8
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    • pp.832-838
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    • 2005
  • Purpose : Mycoplasma pneumoniae infection is relatively common in childhood. Its extrapulmonary manifestations have been reported so much, but hepatitis associated with it has been reported rarely in Korea. Methods : A clinical study was performed on 556 patients of M. pneumoniae pneumonia diagnosed serologically at Gil hospital from January 2001 to December 2004. We reviewed 65 cases among these patients, who had elevated level of serum AST and ALT greater than 50 IU/L respectively without evidence of hepatitis A, B, C, Cytomegalovirus and Ebstein-Barr virus infections. Results : Hepatitis occurred in 11.7% of Mycoplasma pneumoniae pneumonia, especially in fall and winter times. Male to female ratio was 1.2 : 1 and the mean age was 4 years and 3 months. Besides hepatitis, cough(95.4%), sputum(52.3%) and dyspnea(12.3%) were common as pulmonary manifestations. And among gastrointestinal manifestations, nausea/vomiting(26.2%) was the most common symptom, followed by poor oral intake(12.3%), diarrhea(12.3%) and abdominal pain(6.2%). In addition to hepatomegaly(4.6%) and splenomegaly(4.6%), coarse breathing sound was the most common physical manifestation, followed by rale(63.1%), pharyngeal injection(26.2%), and rash(10.8%). Anemia was noted in 20.0%, neutrophilia in 10.8%, eosinphilia in 38.5% and thrombocytosis in 6.2%, respectively. Mean level of ESR and CRP was 32.02 mm/hr and 6.69 mg/dL, respectively. Mean level of AST and ALT was 293.80 IU/L and 181.48 IU/L, respectively. Hyperbilirubinemia was noted in 7.7% and hypoalbuminemia was noted in 58.5%. Lobar or lobular pneumonia(78.5%) was the most common finding in chest X-ray and left lower lobe(39.2%) was most commonly affected. Pleural effusion was noted in 26.2%. Mean duration of hospitalization was 9.91 days. Serum AST/ALT level was normalized within 9.94 days and pulmonary consolidation resolved within 14.29 days. Conclusion : The prognosis of M. pneumoniae hepatitis is good. However, liver function should be considerately checked in M. pneumoniae infection because its incidence is not so low.

Airway Compression or Airway Anomaly Causing Respiratory Symptoms in Infants and Children with Cardiovascular Diseases (심혈관계 질환 환아에서 동반된 기도 압박 및 기도 기형의 임상적 특성)

  • Kim, Ja-Hyeong;Lee, So-Yeon;Kim, Hyo-Bin;Koo, So-Eun;Park, Sung-Jong;Kim, Young-Hui;Park, In-Suk;Ko, Jae-Gon;Seo, Dong-Man;Hong, Soo-Jong
    • Clinical and Experimental Pediatrics
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    • v.48 no.7
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    • pp.737-744
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    • 2005
  • Purpose : Infants and children with cardiovascular diseases often present with respiratory symptoms. However, missed or delayed evaluation for potential airway problem may complicate overall prognosis. The aim of this study is to determine the clinical characteristics of these patients and explore the cause of airway problem. Methods : We reviewed the medical records of 64 patients(M : F=33:31, mean age : $6.3{\pm}7.5$ months) whose airway problems were proven by computed tomography or bronchoscopy in perioperative periods at the Asan Medical Center from January 1997 to June 2004. Patients were divided into two groups based on the duration of ventilator care : ${\leq}7$ days(group 1 : 23 cases, M : F=10 : 13) and >7 days(group 2 : 41 cases, M : F=23 : 18). Results : The patients in group 2 significantly developed more post-operative respiratory symptoms than group 1(P<0.001) and had more airway problems including extrinsic obstruction, intrinsic anomaly, and combined problem than group 1 although not significantly different(P=0.082). Among underlying diseases, the most common diseases were vascular anomaly(26.2 percent) and aortic arch anomaly(26.2 percent) in group 1 and pulmonary atresia with ventricular septal defect(22.4 percent) in group 2. The most frequent respiratory symptoms were recurrent wheezing pre-operatively and failure of ventilator weaning post-operatively. The major types of airway anomaly were tracheomalacia and tracheal stenosis(in each case 18.2 percent). Nineteen patients with persistent airway problems underwent aortopexy or other vascular correction. Of the 19 patients, 13(68.4 percent) were improved, but 2 failed in weaning ventilator and 4 died of non-airway problems. Conclusion : Early evaluation and treatment for potential airway problems may affect natural or surgical prognosis in patients with cardiovascular diseases presenting with respiratory symptoms.

Comparison of Acute Clinical Features and Coronary Involvement in Patients with Kawasaki Disease between Those Younger and Older than One Year of Age (1세 미만과 1세 이상의 가와사끼병 환아에서 급성기 임상양상 및 관상동맥 변화에 대한 비교)

  • Kim, So Young;Lim, Seong Joon;Yun, Sin Weon;Lee, Dong Keun;Choi, Eung Sang
    • Clinical and Experimental Pediatrics
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    • v.45 no.6
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    • pp.773-782
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    • 2002
  • Purpose : To identify the necessity of more reasonable diagnostic criteria and the possibility of early prediction of coronary involvement in the higher risk group, we investigated and compared clinical and laboratory findings in the acute phase and coronary involvements in those younger (n=17) and older(n=53) than one year of age in Kawasaki disease(KD). Methods : Retrospective chart reviews were performed on 70 patients with KD who were admitted to the Chung-Ang University Hospital from April 1997 to May 2001. Results : Male were significantly higher in the younger age group(M : F ratio 3.3 : 1 vs. 1.0 : 1, P=0.004). Fever durations before intravenous immunoglobulin(IVIG) and echocardiography were significantly shorter in the younger group($4.6{\pm}1.3$ vs. $6.2{\pm}2.5$, P=0.004 vs. 0.01, respectively). Cases meeting typical diagnostic criteria were significantly less in the younger group(P=0.006). In the laboratory findings, serum albumin, BUN and $K^+$ levels in the acute febrile phase were significantly higher in the younger group(P=0.002, 0.006, <0.001, respectively) and incidences of coronary artery dilatation in the acute phase were significantly higher in the younger group(P=0.01). Conclusion : Although less met the typical diagnostic criteria of KD, infants younger than one year of age are more susceptible to coronary artery change in the acute febrile phase. Therefore, KD should be entertained as a diagnostic possibility in young infants with prolonged fever without distinct fever focus, and echocardiography should be considered as part of the evaluation of these patients, and then early diagnosis and prompt IVIG should be conducted.