• Neonatal Medicine
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• v.15 no.2
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• pp.151-159
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• 2008

Purpose : This study determined the prenatal and postnatal factors associated with complications and prognosis in premature infants with leukemoid reaction. Methods : We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and low birth weights (<2,500 g) who were admitted immediately after birth to the neonatal intensive care unit at the Dongguk University Ilsan Hospital between June 2005 and July 2006. A leukemoid reaction was defined as an absolute neutrophil count (ANC) >30,000/$mm^3$. The infants who had leukemoid reaction comprised the study group, while the remainder of infants made up the control group. The relationships between maternal and neonatal variables and ANC were studied. Results : Leukemoid reaction was detected in 3.1% of the study infants (8 of 252). Factors more frequently associated with infants with leukemoid reaction were as follows: maternal chorioamnionitis, high levels of maternal and infant C-reactive protein, gestational age <37 weeks, birth weight <2,500 g, low Apgar score, prolonged ventilator support, and a high incidence of bronchopulmonary dysplasia (BPD). However, there were no significant differences with respect to the antenatal usage of steroids, the incidences of patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, and mortality between the two groups. Conclusion : Leukemoid reaction in premature infants was associated with chorioamnionitis and high levels of serum C-reactive protein in mothers and infants, and BPD in infants. These findings suggest that leukemoid reaction is secondary to inflammation caused by infection.

• Journal of agricultural medicine and community health
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• v.26 no.1
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• pp.65-79
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• 2001

Cerebrovascular disease(CVD) is one of the major causes of death in Korea as well as most countries in the world and the disease gives great burden to humans socio-economically due to its high fatality and common occurrence of disability as the sequelae. This study was performed to investigate the utilization of western hospital(WH) or oriental hospital(OH) due to CVD and compare the type and the clinical characteristics of patients with CVD between WH and OH located in Kwangju City, Chonnam Province and Chonbuk Province. We reviewed the medical records of 1,070 patients who were discharged from 12 WIT and 6 OH from January to March, 2000 and confirmed for the diagnosis of CVD. Fifty-one percent of the subjects were treated at WH and forty-nine percent at OH. Females were more prevalent than males. As well, the most common age group among these subjects was found to be 70 years and older. About 92% in W~H and 80% in OH received brain imaging diagnostic procedures such as CT or MRI. The cerebral infarction was the most common type of CVD when compared by the kind of utilized hospitals, sex, age group except patient Group who was treated at WH and whose age was lower than 50 years old. The cerebral hemorrhage was more frequent than cerebral infarction among this group. The proportion of cerebral hemorrhage was decreasing and that of cerebral infarction was increasing with age. The most common clinical manifestations of undetermined type of CVD was paralysis of lower extremity in WIT and paralysis of upper extremity in OH. In cerebral hemorrhage loss of consciousness in WIT and dysarthria in OH were most frequently manifested, while in the case of cerebral infarction hemiplegia in WIT and dysarthria in OH were the most common complaints. The interval from the onset of disease to admission to the hospital was 5.5 days in WH arid 31.4 days in OH and the difference was statistically significant. Average admission duration of patients at OH was longer than WH, but it was not statistically significant. In conclusion these results suggest that the effort for systematic and efficient management of CVD patients was necessary for close co-operation and role arrangement between WH and OH considering the positive and negative points of western and oriental medicines.

• Clinical and Experimental Pediatrics
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• v.50 no.3
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• pp.268-271
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• 2007

Purpose : Premature narrowing of the foramen ovale is rare but serious clinical entity. Prenatal narrowing or obstruction of the foramen ovale shows symptoms such as right heart failure, fetal hydrops, triscupid regurgitation, left heart obstructive disease, and supraventricular tachycardia. This study aimed to assess the prenatal diagnosis and postnatal clinical course of restrictive foramen ovale in utero in otherwise normal heart. Methods : The subjects were five patients diagnosed with restrictive foramen ovale in utero from January 2001 to June 2005 at Chungnam National University Hospital. The diagnostic criteria was defined when the maximum diameter in a 4-chamber view is less than 2.5 mm and there is a continuous doppler velocity at the foramen ovale of more than 0.6m/s. Results : At the time of diagnosis of restrictive foramen ovale, gestation age was 34~37 wks, and chief complaints were fetal arrhythmia(2 cases), pericardial effusion, Ebstein anomaly and subaortic stenosis. Two cases which were diagnosed fetal hydrops and supraventricular tachycardia delivered by emergent cesarian section. Five cases were found to have right heart dilatation on echocardiogram after birth, but right heart dilatation became normalized at day 7 after birth and the clinical courses were not eventful. Conclusion : Identifying an obstructed foramen ovale in the fetus warrants the further search for additional cardiac and extracardiac anomalies, which may alter the prognosis. Delivery should be induced if possible in cases of foramen ovale obstruction with signs of cardiac decompensation.

• Journal of Chest Surgery
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• v.36 no.4
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• pp.267-272
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• 2003

Background: Common treatment modalities for tracheal stenosis include conservative methods such as repeated balloon dilatation, removal of obstructive material through bronchoscopy and T-tube insertion as well as operative treatment methods. Recent advances in surgical approaches through tracheal resection and end-to-end anastomosis have been reported to give better functional and anatomical results. Material and Method: Between March 1990 and July 2002, 41 patients who received tracheal resection and end-to-end anastomosis at Asan Medical Center, University of Ulsan were studied retrospectively. Result: The causes for tracheal resection and end-to-end anastomosis included 26 cases of postintubation stenosis, 10 cases of primary tracheal tumors (3 benign, 7 malignant), 1 case of endobronchial tuberculosis, 2 cases of traumatic rupture, and 2 cases of tracheal invasion of a thyroid cancer, Of the 41 patients who received tracheal resection and reconstruction, 29 received tracheal resection and end-to-end anastomosis, and 12 received laryngotracheal anastomosis with cricoid or thyroid cartilage resection. Four of these patients received supralaryngeal release. The average length of the resected trachea was $3.6{\pm}1.0$cm. Of the 41 patients who received tracheal resection and end-to-end anastomosis, 30 (73.2%) experienced no postoperative complications, and 8 (19.5%) experienced granulation tissue growth and/or minor infections which improved after conservative management. Good or satisfactory results were therefore achieved in 92.7%. Complications included repeated granulation tissue growth in 7, wound infection in 2, anastomotic site dehiscence in 2, restenosis resulting in dyspnea on exertion in 1, and repeated postoperative aspiration requiring retracheostomy in 1. There was no early postoperative mortality. There were 3 cases of hospital death. Conclusion: In cases of proper length of tracheal lesion, excellent results were obtained after tracheal resection and end-to-end anastomosis. But, granulation tissue growth is so serious complication, it is necessary for continuous study and efforts to prevent it.

• Journal of the Korean Society of Radiology
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• v.84 no.3
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• pp.606-614
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• 2023

Purpose This study aimed to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for bleeding due to uterine body cancer. Materials and Methods In this retrospective study, six patients with varying types of uterine body cancer who underwent TAE for bleeding control were investigated. Angiographic findings, cross-sectional images, TAE details, and clinical outcomes were studied. Technical and clinical success rates were calculated. Results The identified patients had endometrioid adenocarcinoma, sarcoma, and gestational trophoblastic neoplasia, and most were patients with advanced-stage cancer. In four patients, tumor bleeding presented as vaginal bleeding. Technical success was achieved in all seven TAE procedures in six patients. Two patients with recurrent masses who had undergone hysterectomy presented with hematochezia, and TAE was able to provide technical success in these patients as well. The clinical success rate was 50%, indicating bleeding control for > 1 week. Rebleeding was directly associated with death in one patient. On the following day, mild fever was observed in one patient. Conclusion TAE can be considered an effective and safe method of bleeding control for uterine body cancer, especially during critical periods throughout the disease course of patients with inoperable, advanced-stage cancer.

• Clinical and Experimental Pediatrics
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• v.52 no.8
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• pp.881-887
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• 2009

Purpose : The survival rate of very low birth weight infant (VLBWI) had increased as a result of advances in neonatal intensive care. We evaluated the changes in outcomes of VLBWI who admitted to the neonatal care unit of Hallym University Kangnam Sacred Heart Hospital. Methods : Retrospective review of 339 VLBWI who were born from 1st January 1997 to 31th December 2008 were performed. Outcomes including survival rate, birth weight (BW), gestational age (GA), morbidities, and mortality between period I (1997- 2003) and period II (2004-2008) were compared. Results : Overall incidence of VLBWI was 2.3% and it was significantly higher in period II(3.3%). Mean BW and GA were significantly decreased in period II (P<0.001, P=0.01). The survival rate increased from period I (59.1%) to period II (74.2%). BW-specific survival rate increased in 1,000-1,249 gm and GA-specific survival rate significantly increased in 27-28 weeks and 29-30 weeks. The incidences of respiratory distress syndrome (RDS), retinopathy of prematurity (ROP), sepsis, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, periventricular leukomalacia, and necorotizing enterocolitis were same except patent ductus arteriosus. Conclusion : The survival rate of VLBWI was increased in period II, especially in less than 1,000 gm and below 27 weeks. This may be due to recent dramatic improvement of neonatal care. But more efforts are needed to improve outcome during initial phase and to reduce long term complication such as BPD and ROP.

• Clinical and Experimental Pediatrics
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• v.48 no.3
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• pp.260-265
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• 2005

Purpose : During epidemics, influenza induces a high mortality and morbidity, and when influenza is prevalent, it is revealed by increased pneumonia, hospitalization due to influenza-like illness, and mortality in community. We aimed at the isolation of influenza virus and prevalence period in Busan from 2000 to 2002. Methods : For 3 years from 2000 to 2002, we analyzed the patterns of influenza virus, the occurrence distribution of influenza by age and sex and the prevalence period after cultivating the examined materials from throat smears and snivel, collected from patients in St. Benedict Hospital Pediatrics Department, from 10 monitoring hospitals, and from 16 public health centers. Results : For three years, a total of 209 strains of influenza virus were isolated. In 2000, there were A/sydney/05/97(H3N2)-like, A/Beijing/262/95(H1N1)-like and B/Harbin/07/94-like. In 2001, there were A/Panama/2007/99(H3N2)-like and A/Newcaledonia/20/99(H1N1)-like. In 2002, there were A/Panama/2007/99(H3N2)-like, A/Newcaledonia/20/99(H1N1)-like, B/Beijing/243/97, B/Honkong/22/2001 and B/Sichuam/379/99. The occurrence distribution by sexes were 14 males and 25 females in 2000, 23 males and 33 females in 2001, 57 males and 57 females in 2002. As for the occurrence distribution by ages, 0-10 years made up 48.4 percent in 2000, 11-20 years 33.93 percent in 2001, and below 10 years was 64.91 percent in 2002. As for the occurrence distribution by month, the rate was once high in January and somewhat high in April and by June, when there happened to be various viruses, though there was a low rate in 2000. On the other hand, the virus was concentrated in February and March in 2001. And in 2002, it happened high twice, in March and November. Conclusion : Influenza virus revealed frequent antigenic changes and infect children, especially those below 10 years of age from late fall to early spring. So we should consider appropriate prevention in children.

• Clinical and Experimental Pediatrics
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• v.50 no.1
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• pp.56-64
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• 2007

Purpose : This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. Methods : One hundred and ninety-seven episodes of bloodstream infections that developed in 128 pediatric cancer patients were analyzed, which were identified at the Seoul National University Children's Hospital during a 4 year-period from 2002 to 2005. Results : A total of 214 pathogens was isolated, of which 64.0 percent were gram-negative, 31.3 percent were gram-positive bacteria, and 4.7 percent were fungi. The most common pathogens were Klebsiella spp. (21 percent) and Escherichia coli (16.8 percent), and coagulase-negative staphylococci (CNS, 7.9 percent) and viridans streptococci (7.5 percent) emerged as important pathogens. Neutropenic patients were more often associated with gram-negative bacteria than non-neutropenic patients (67.5 percent vs. 51.1%, P=0.018) and patients with central venous catheters were more often associated with CNS and viridans streptococci than those without. Resistance rates of gram-positive bacteria to penicillin, oxacillin and vancomycin were 83.3 percent, 48.5 percent and 0.5 percent, respectively, and those of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin and amikacin were 24.1 percent, 17.2 percent, 6.6 percent, 21.6 percent, and 14.2 percent, respectively. Gram-negative bacteremias were more often associated with intensive care than gram-positive bacteremias (26.5 percent vs. 10.3 percent, P=0.016), and patients with catheters were more often associated with intensive care (34.4 percent vs. 10.8 percent, P<0.001) and higher fatality rate (16.7 percent vs. 4.8 percent, P=0.012) than those without. Conclusion : This study revealed that gram-negative bacteria are still a dominant organism in bloodstream infections, especially in neutropenic patients, and confirmed that gram-positive bacteria are emerging as important etiological agents in bloodstream infections of pediatric hemato-oncologic patients.

• Journal of Preventive Medicine and Public Health
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• v.16 no.1
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• pp.153-156
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• 1983

1950년(年) 이후(以後) 무연탄(無煙炭)으로 만든 연탄(煉炭)을 취사(炊事), 난방용(煖房用)으로 가정(家庭)에서 광범위(廣範圍)하게 사용(使用)하게 되면서 연탄(煉炭)가스내(內)의 일산화탄소(一酸化炭素)로 인(因)한 중독사고(中毒事故)가 빈발(頻發)하여 심각(深刻)한 국민보건(國民保健)의 문제(問題)가 되어왔다. 저자(著者)들의 실태조사(實態調査)(1975년도(年度))에 의(依)하면 서울특별시일원(特別市一圓)에 있어 일산화탄소중독(一酸化炭素中毒)의 년간발생(年間發生)은 인구(人口), 10만당(萬當) 경증(輕症) 260명(名), 혼수상태(昏睡狀態)의 중증중독(重症中毒) 45명(名), 사망(死亡) 1명(名)으로 위험인구(危險人口)를 3,000만명(萬名)으로 하였을 때 전국적(全國的)으로 일산화탄소중독(一酸化炭素中毒)의 추정발생수(推定發生數)는 년간(年間) 경증(輕症) 78만명(萬名), 중증(重症) 13만(萬) 5천명(千名), 사망(死亡) 3,000명(名)으로 그 피해(被害)의 규모(規模)가 100만을 육박(肉薄)하는 가공(可恐)할 수자(數字)를 보여주고 있다. 저자(著者)들은 이러한 심각(深刻)한 국민보건(國民保健)의 문제(問題)를 우선(于先) 실천가능(實踐可能)한 제이차예방(第二次豫防)에 역점(力點)을 두어 고압산소요법(高壓酸素療法)을 보급(普及)할 목적(目的)으로 일인용고압산소장치(一人用高壓酸素裝置)를 개발(開發)하고 1969년(年) 1월(月)에 서울대학교병원(大學校病院)에 고압산소치료실(高壓酸素治療室)을 개설(開設)하여 급성일산화탄소(急性一酸化炭素) 중독환자(中毒患者)에 대(對)한 응급치료(應急治療)를 실시(實施)하여 1978년(年)까지 10년간(年間)의 치료결과(治療結果)를 요약(要約)한바 다음과 같다. 1. 총치료환자수(總治療患者數)는 2,242명(名)이고 회복(回復)된 수(數)는 2,202명(名)으로 98.2%의 회복률(回復率)을 보였다. 2. 계절적(季節的)으로 10월(月)에서 4월(月)까지가 연중최성기(年中最盛期)이나 5월(月)에서 9월(月)까지도 적지않은 환자(患者)의 발생(發生)을 볼 수 있었다. 3. 연령별분포(年齡別分布)를 보면 15세(歲)${\sim}29$세군(歲群)이 전체환자(全體患者)의 반이상(半以上)인 52.7%를 차지하고 있고 $0{\sim}14$세군(歲群)은 인구비(人口比)에 대해 발생(發生)이 훨씬 적은 결과(結果)를 보이고 있다. 4. 도착시간별(到着時間別) 입원율(入院率)은 오전(午前) 10시이후(時以後) 도착군(到着群)서부터는 입원율(入院率)이 급증(急增)하는데 이는 병원도착(病院到着)이 늦일수록 당일회복(當日回復)이 되지못하고 입원가료(入院加療)하게 됨을 나타내주는 결과(結果)라 할 수 있다. 5. 병발증(倂發症)으로는 급성욕창, 폐렴(肺炎) 및 신경학적(神經學的) 이상등(異常等)의 소견(所見)을 많이 볼 수 있었다.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.27-34
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• 2004

Background: Infective endocarditis shows higher operative morbidity and mortality rates than other cardiac diseases. The vast majority of studies on infective endocarditis have been made on aortic endocarditis, with little attention having been paid to infective endocarditis on the mitral valve. This study attempts to investigate the clinical aspects and operative results of infective endocarditis on the mitral valve. Meterial and Method: The subjects of this study consist of 23 patients who underwent operations for infective endocariditis on the mitral valve from June 1995 to May 2003. Among them, 2 patients suffered from prosthetic valvular endocarditis and the other 21 from native valvular endocarditis. The subjects were evenly distributed age-wise with an average age of 44.8$\pm$15.7 (11∼66) years. Emergency operations were performed on seventeen patients (73.9%) due to large vegetation or instable hemodynamic status. In preoperative examinations, twelve patients exhibited congestive heart failure, four patients renal failure, two patients spleen and renal infarction, and two patients temporary neurological defects, while one patient had a brain abscess. Based on the NYHA functional classification, seven patients were determined to be at Grade II, 9 patients at Grade III, and 6 patients at Grade IV. Vegetations were detected in 20 patients while mitral regurgitation was dominant in 19 patients with 4 patients showing up as mitral stenosis dominant on the preoperative echocardiogram. Blood cultures for causative organisms were performed on all patients, and positive results were obtained from ten patients, with five cases of Streptococcus viridance, two cases of methicillin-sensitive Staphylococcus aureus, and one case each of Corynebacteriurn, Haemophillis, and Gernella. Operations were decided according to the AA/AHA guidelines (1988). The mean follow-up period was 27.6 $\pm$23.3 (1 ∼ 97) months. Result: Mitral valve replacements were performed on 43 patients, with mechanical valves being used on 9 patients and tissue valves on the other 4. Several kinds of mitral valve repair or mitral valvuloplasty were carried out on the remaining 10 patients. Associated procedures included six aortic valve replacements, two tricuspid annuloplasty, one modified Maze operation, and one direct closure of a ventricular septal defect. Postoperative complications included two cases of bleeding and one case each of mediastinitis, low cardiac output syndrome, and pneumonia. There were no cases of early deaths, or death within 30 days following the operation. No patient died in the hospital or experienced valve related complications. One patient, however, underwent mitral valvuloplasty 3 months after the operation. Another patient died from intra-cranial hemorrhage in the 31st month after the operation. Therefore, the valve-related death rate was 4.3%, and the valve-related complication rate 8.6% on mid-term follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, follow-up. 1, 3-, and 5-year valve- related event free rates were 90.8%, 79.5%, and 79.5%, respectively, while 1, 3-, and 5-year survival rates were 100%, 88.8%, and 88.8%, respectively. Conclusion: The findings suggest that a complete removal of infected tissues is essential in the operative treatment of infectious endocarditis of the mitral valve. It is also suggested that when infected tissues are completely removed, neither type of material nor method of operation has a significant effect on the operation result. The postoperative results also suggest the need for a close follow-up observation of the patients suspected of having brain damage, which is caused by preoperative blood contamination or emboli from vegetation, for a possible cerebral vascular injury such as mycotic aneurysm.