• Childhood Kidney Diseases
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• v.1 no.2
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• pp.117-122
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• 1997

Purpose : To clarify the clinical findings, laboratory findings and disease course of EP complicated with CAPD and to find out possible predisposing factors to EP. Methods : The medical records of 34 children who underwent CAPD at our hospital between Jan. '94 and Dec. '96 were retrospectively reviewed. The clinical features and laboratory findings of EP were analyzed, and several parameters were evaluated as predisposing factors of EP. Results : EP developed in 7(21%) out of 34 patients. The major symptom of EP was turbid peritoneal fluid without fever, abdominal pain or disturbance of drainage in all cases. The microbiologic culture studies of the peritoneal fluid resulted negative in all cases. Patients with peripheral blood eosinophilia before insertion of CAPD catheter had higher risk of EP than those without eosinophilia (P=0.002). And peripheral blood eosinophilia, noted after insertion of hemodialysis catheter in cases with previous hemodialysis before CAPD, showed significant correlation with the occurrence of EP (P=0.016), too. However, there was no significant correlation between peripheral blood eosinophilia noted after insertion of CAPD cathter and the occurrence of EP. Identification of eosinophils in peritoneal fluids was more accurate with cytospin analysis. Conclusions : An early and accurate diagnosis of EP in patients with CAPD can prevent unnecessary treatment of antibiotics. Peripheral blood eosinophilia before insertion of CAPD catheter is one of the predisposing factors of EP. And, cytospin analysis of peritoneal fluid is an accurate method for diagnosis of EP.

• Childhood Kidney Diseases
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• v.11 no.1
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• pp.41-50
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• 2007

Purpose : Dialysis in children with chronic renal failure presents with many difficulies. The purpose of this study is to find an improved method in chronic dialysis in infants and children less than 2 years of age by analyzing the experience with 10 cases. Methods : A retrospective review of the medical records of 10 patients(6 boys and 4 girls) was conducted. The patients had chronic renal failure and underwent chronic dialysis at Samsung medical center from March 1999 to February 2007. Results : At Initiation of dialysis, the median age was 3 months old(22 days-20 months), the median body weight was 3.75 kg(2.2-10.3 kg), and the median serum creatinine level was 4.3 mg/dL(2.0-11.4 mg/dL). The median duration of dialysis was 29.5 months(3-62 months). Dysplastic kidney disease was the most common underlying renal disease. Two patients were treated with hemodialysis, 4 patients with peritoneal dialysis, and 4 patients eventually switched dialysis modality. Nine of the 10 patients took erythropoietin and anti-hypertensive drugs. At the end of the follow up period, 1 patient received kidney transplantation, 2 patients died due to sepsis, and 5 patients were treated with peritoneal dialysis. Two patients were lost to follow up. The most common complication of dialysis was infection. Achieving vascular access and maintaining proper catheter function were the most important factors in treating patients with hemodialysis. The growth status of patients was aggravated after 6 month of dialysis but improved after 1 year of dialysis. Patients showed better growth on peritoneal dialysis than hemodialysis. Conclusion : Chronic dialysis can be performed successfully in infants and children under 2 years of age. Vascular access was the main limitation of hemodialysis, and infection was the common problem in both hemodialysis and peritoneal dialysis. To improve the patients survival rate and quality of life, major efforts should be directed toward the prevention of infection and preservation of catheter function. (J Korean Soc Pediatr Nephrol 2007;11:41-50)

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.38-46
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• 2008

Purpose: Growth failure is a common problem in chronic renal failure(CRF). We studied the effect of growth hormone(GH) treatment and the factors influencing growth on chronic peritoneal dialysis patients. Methods: Seventeen patients who were treated with peritoneal dialysis and GH for more than one year were enrolled. Factors influencing growth such as age, height at start of GH treatment, total Kt/Vurea, residual renal Kt/Vurea, hemoglobin, albumin, BUN, creatinine, total $CO_2$, calcium, phosphate and iPTH during GH treatment were compared between the growth group (increase in height-standard deviation score(Ht-SDS) after one year of GH treatment, n=l1) and poor growth group(no increase in Ht-SDS after one year of GH treatment, n=6). Results: The mean age at the start of dialysis was 7.7${\pm}$5.2 years and the mean age at the start of GH treatment was 8.5${\pm}$4.8 years. In the growth group, Ht-SDS at start of GH treatment was smaller(-1.72${\pm}$1.00 vs. -0.77${\pm}$0.88, P=0.048) and residual renal Kt/Vurea was better (1.54${\pm}$0.51 vs. 0.15${\pm}$0.26, P=0.02) than the poor growth group. After three years of GH treatment, Ht-SDS of the growth group was better than the poor growth group. Conclusion: GH treatment in children with peritoneal dialysis was more effective on patients who had more severe growth retardation. The reservation of residual renal function was important for improvement of effect of GH treatment. And the growth response during the first year of GH treatment may be predicted as the indicator for long-term response.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.338-344
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• 2001

배경: 말기 신부전 환자에서 심장병, 특히 관상 동맥 질환의 이환이 늘어나면서 관상동맥 우회수술의 대상 환자가 지속적으로 증가하고 있다. 이들 환자군은 수술후 유병률과 사망률이 매우 높고 고위험군으로 알려져 있다. 대상 및 방법: 1996년 3월부터 2000년 5우러까지 서울 중앙 병원 흉부외과에서 술전 말기 신부전증으로 진단 받은 후 관상 동맥 우회수술을 시행받은 환자 25명을 대상으로 의무 기록을 중심의 후향적 분석을 하였다. 술전 위험 인자 및 술전 신기능, 수술 결과, 술후 경과, 수술후 합병증, 사망률 및 생존률 등을 분석하였다. 결과: 술전 평균 크레아티닌 청소율은 12.7$\pm$5ml/mim였고 술전 평균 혈중 크레아티닌 치는 6.2$\pm$3mg/dl(1.7-14.4)였다. 술전 투석을 시행중인 환자는 11례(44%)였고 술전 투석을 시행하지 않았던 14례(56%)중 8례(8/14, 57.1%)는 수술전후로 새로이 투석이 필요하였다. 술전 혈액 투석 중이었던 9례중 2례에서 수술후 복막 투석으로 전환하였다. 수술 사망률은 2례(8%)로 흡인성 폐렴과 종격동염으로 1례, 그리고 수술후 출형과 종격도염으로 1례가 사망하였다. 수술후 합병증은 14명(56%)의 환자에서 발생하여 매우 높은 발생율을 보였다. 만기사항은 2례(8%)에서 발생하였으며 사망원인은 카테터에 의한 복막염이었다. 생존 환자의 4년 생존률은 82$\pm$13% 였다. 결론: 말기 신부전 환자에서의 관상동맥 우회수술을 비교적 만족스러운 범위의 수술 사망률(8%)을 보였으나 합병증 발생률이 매우 높고 합병증 발생 시 사망률이 매우 높아 수술주위 감염 예방과 세심한 환자 관리가 필요하다.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.525-528
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• 2010

Congenital interruption of the inferior vena cava (IVC) can lead to secondary hepatic congestion, portal hypertension, and liver cirrhosis. A 49-year-old woman was admitted to the gynecology department with symptoms of menorrhalgia, known uterine myoma, and anemia. Abdominal computed tomography (CT) and venography performed at our hospital revealed congenital interruption of the IVC. The patient underwent retrohepatic cavoatrial bypass surgery with a polytetrafluoroethylene (PTFE) 16-mm ringed graft via posterolateral thoracotomy, and recovered without major complications. A retroperitoneal approach via posterolateral thoracotomy provides appropriate visualization during dorsal cavoatrial bypass in treating patients with congenital interruption of IVC.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.239-244
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• 2008

Calcification in patients with endstage renal disease on renal replacement therapy can occur in extraskeletal area such as conjunctiva and cornea. Conjunctival and corneal calcification(CCC) has mostly has been reported in adults with endstage renal disease on hemodialysis. CCC seems to be associated with the duration of renal replacement therapy, and high Ca$\times$P value. We report a 10-year-old girl who was on peritoneal dialysis for 31 months and presented with CCC on both eyes. Her corneal calcification was resolved after the epithelial debridement and ethylenediaminetetraacetic acid(EDTA) soaking therapy.

• Journal of Digestive Cancer Research
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• v.4 no.1
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• pp.32-35
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• 2016

Pseudomyxoma peritonei (PMP) is a rare clinical syndrome characterized by profuse jelatinous materials in the abdominal cavity and pelvis with mucinous implants on the peritoneal surface. There are some studies for serum tumor markers, including carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125), to assess the risk of recurrence following cytoreductive surgery and intraperitoneal chemotherapy. However, rare cases were reported about recurrence with increasing serum CEA levels. Herein, we report a case of recurrence of PMP according to serially elevated serum CEA.

• Childhood Kidney Diseases
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• v.6 no.1
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• pp.56-60
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• 2002

Purpose Streptococcus pneumoniae is a major pathogen in both adults and children, causing significant morbidity and mortality In patients with nephrotic syndrome, Streptococcus pneumoniae is a major cause of spontaneous peritonitis, and the increasing incidence of penicillin-resistance strain facilitates the development of effective vaccine. The limitation of current pneumococcal polysaccharide vaccine prompted development of polysaccharide- protein conjugate vaccine. Methods: We reviewed the medical record of total 225 steroid responsive nephrotic patients to ascertain the effectiveness of 23- valent pneumococcal polysaccharide vaccine. Results. Twenty- eight patients have developed peritonitis during the courses, and 7 of those have recurrent peritonitis. Fifty- five patients were vaccinated and followed- up for 1- 108 months (mean 38.5 months), and during the follow- up period, pneumococcus related peritonitis was not detected. Vaccine- related relapse of nephrotic syndrome w as absent. Conclusion: In spite of the non- consensus about the efficacy of PPV23, clinically it benefits, and until the clinical trial of PCV7 is completed, PPV23 will be recommended. (J Korean Soc Pediatr Nephrol 2002;6: 56-60)

• Clinical and Experimental Pediatrics
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• v.52 no.11
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• pp.1216-1220
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• 2009

Purpose:To analyze and compare various cases in which peritoneal drainage was used as the primary treatment method in preterm infants with intestinal perforation. Methods:Among the preterm infants of less than 28 weeks of gestation who were admitted to the neonatal intensive care unit (NICU) at the Gangnam Severance Hospital from April 2006 to April 2009, 7 who had developed intestinal perforation were studied retrospectively. We investigated the clinical characteristics, secondary operation performances, morbidities, complications, and mortalities. Results:Among the 7 infants, 5 survived. Of the 5 cases, 3 received laparotomy, of which 2 were confirmed as having necrotizing enterocolitis. Of the 2 infants who died, 1 had received laparotomy before 48 h of peritoneal drainage, while the other had not received any subsequent treatment. Of the 7 children, 4 had patent ductus arteriosus (PDA), of which 3 had received indomethacin injection. Five infants had begun enteral feeding before they developed intestinal perforation. Of the 5 infants who survived, 4 were diagnosed with cholestasis. Of the 7 infants, 4 developed periventricular leukomalacia (PVL) and 3 developed rickets. Conclusion:Although the use of peritoneal drainage as the primary management of intestinal perforation in preterm infants is controversial, we suggest that it can be used for treating extreme premature neonates. Further randomized controlled study will be required to determine the feasibility of using this method.

• Korean Journal of Head & Neck Oncology
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• v.14 no.1
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• pp.99-102
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• 1998

혈관외피세포종(Malignant hemangiopericytoma)은 난원형의 혈관외피세포(pericyte)들로 구성된 매우 드문 혈관종의 일종으로 대개 사지 및 후복막에 발생되며, 안면부와 경부에도 약 25%가량의 발생율이 보고되어 있다. 성별 발생빈도의 차이는 없고 $20{\sim}50$대에서 호발하며, 종양은 대부분 서서히 성장하고 경계가 명확한 무통성의 고형 종괴로 나타난다. 악성과 양성의 구별은 조직학적 소견과 주변 조직으로의 침습, 원격전이 여부 등을 고려하여 판단하지만, 양성으로 진단된 경우에도 수년 내에 재발 및 원격전이가 나타나는 경우가 다수 보고되므로 악성과 양성의 감별이 매우 어렵고. 양성인 경우에도 악성 잠재성이 존재하는 것으로 알려졌다. 치료는 수술적 완전절제가 유일한 방법이나 절제가 불완전한 경우는 수술 후 외부 방사선 조사를 한다. 항암제 투여는 효과면에서 논란이 있지만, 원격전이나 수술과 방사선 치료가 실패한 경우 시행할 수 있다. 저자들은 최근 안면부에 발생한 악성 혈관외피세포종 환자 1예를 치험하였기에 보고하는 바이다.