• Clinical and Experimental Pediatrics
• /
• v.46 no.5
• /
• pp.490-494
• /
• 2003

Purpose : We'd like to determine the incidence of congenital heart disease and arrhythmia in elementary school children in Busan, and to provide adequate prevention and treatment. Methods : A total of 23,802(male 12,909, female 10,893) 1st grade elementary school children living in Busan were studied. All children were 7-8 years old. We obtained their medical history by questionnaire and checked elecrocardiography(ECG). Subsequent screening tests including a 2nd ECG, chest X-ray, phonocardiogram and CBC for the students who had abnormal findings at the first screening test. The third screening test was done for students who had cardiac murmurs or abnormal ECG findings in the second screening test by echocardiogram, treadmill test and 24-hour Holter monitoring. Results : Among 23,802 children participants, 605(2.54%) had abnormal ECG findings at the first screening test. Q wave abnormality(0.58%) was observed most frequently, and complete right bundle branch block(RBBB)(0.26%), sinus tachycardia(0.24%), right axis deviation(0.22%) and ventricular premature contraction(VPC)(0.21%) followed in order. Four hundred and twenty four children participated in the second ECG screening test. Two hundred and two children(47.6%) had an abnormality such as sinus tachycardia(18.8%), VPC(17.8%), or complete RBBB(17.3%). After completing the third examination including echocardiogram, we couldn't find the students with ventricular tachycardia (VT) or SVT at the third arrhythmia screening test. Conclusion : A high incidence of arrhythmia was found in the 1st grade elementary school children in Busan despite their healthy appearances, although fatal heart diseases were not noted. Early diagnosis, adequate preventative measures and treatment will prevent and decrease the frequency of emergent situations like syncope and sudden death.

• Journal of Chest Surgery
• /
• v.39 no.12 s.269
• /
• pp.900-905
• /
• 2006

Background: Homografts and bioprostheses are most commonly used for Rastelli operation in congenital heart disease, but the limited durability is responsible for multiple reoperations associated with increased morbidity This study evaluated long-term results after Rastelli operation with a mechanical valved conduit. Material and Method: A total of 20 patients underwent Rastelli operation with mechanical valved conduit from January 1990 to July 1992. Operative mortality was 1 of 20 patients, and a retrospective review of 19 patients(10 males, 9 females) was done. Initial diagnosis was congenitally corrected transposition of great arteries(cc-TGA, n=4), complete TGA (n=2), ventricular septal defect with pulmonary atresia(VSD with PA, n=9), truncus arteriosus(n=2), double outlet right ventricle with pulmonary stenosis(DORV with PS, n=2). The mean age at Rastelli operation was $4.6{\pm}3.4$ years, and mean follow-up period was $12.8{\pm}2.7$ years. Patients underwent Rastelli opearation using 16 CarboMedics mechanical valve, and 3 Bjork-Shiley mechanical valve($17{\pm}2$ mm). Result: There were 15 reoperations for failed mechanical valved conduit. The freedom from reoperation at 5 and 10 years was 53% and 37%. Most patients were received oral anticoagulation with warfarin, and maintained the international normalized ratio(INR) of 1.5 to 2.0. There was no anticoagulation or thromboembolism related complication. There was a significant difference in the causes of a conduit failure between early(within 3 years) and late(after 3 years) failure groups. The six patients reported early prosthetic valve failure, mainly due to valvular dysfunction by thrombosis or pannus formation. The other nine patients reported late prosthetic valve failure, mainly due to dacron conduit stenosis at anastomosis sites, whereas their valvar motion was normal except 1 patient. Conclusion: To avoid early prosthetic valve failure, strict anticoagulation therapy would be helpful. About the late development of obstructive intimal fibrocalcific peels within the Dacron conduit, an improvement of conduit material is necessary to reduce late prosthetic valve failure. In selected patients, the long term results were satisfactory.

• Childhood Kidney Diseases
• /
• v.3 no.1
• /
• pp.88-94
• /
• 1999

Purpose : Malformation of urinary tract is among the most common of all congenital anomalies and can progress to irreversible renal damage before diagnosis due to difficulty of early diagnosis. Present study was undertaken to determine the clinical characteristics of urinary tract anomaly and to find out the most appropriate diagnostic and therapeutic measures for children with these anomalies. Methods : During the past 10 years from 1987 to 1998, review of medical records revealed 65 children with congenital anomaly of urinary tract and the following results were obtained. Results : The most common anomalies were ureteropelvic junction obstruction occuring in 26 cases ($36\%$), followed by ureteral duplication in 11 cases, renal agenesis in 10 cases and ureterovesical function obstruction in 7 cases. Complex anomaly of urinary tract was found in 8 cases and anomaly of other systems such as congenital heart disease was detected in 11 cases. The most frequent age group at the time of diagnosis was below 1 year of age constituting 39 cases ($60\%$) and male preponderance was noted as male to female ratio being 2.25:1. Presenting symptoms were urinary tract infection in 25 cases, followed by hematuria, abdominal mass, abdominal pain and voiding difficulty, etc, and in 11 cases, the anomaly was picked up by routine prenatal ultrasonography. Azotemia was noted in 9 cases and the underlying anomaly was obstructive uropathy in 4 out of these 9 cases. Surgical correction was undertaken in 38 cases (most frequently in cases of obstructive uropathy) and in 2 out off cases with obstructive uropathy in whom surgical correction was done, azotemia disappeared during follow up period of 1-5years. No new cases of deteriorating renal function appeared during follow-up period. Conclusion : In spite of high incidence of congenital malformation of urinary tract, early diagnosis is still hampered by nonspecific symptoms and signs. Therefore, in patients with symptoms such as urinary tract infection, abdominal pain and voiding problems, etc, it Is advisable to take various diagnostic tests promptly to pick up any urinary tract anomaly and to apply proper therapy in order to avoid progression to irreversible renal damage. In this regard, prenatal ultrasonography should be utilized more widely as a routine procedure to detect any urinary tract anomalies before birth.

• Childhood Kidney Diseases
• /
• v.2 no.2
• /
• pp.95-103
• /
• 1998

Purpose : To find and solve the common problems of peritoneal dialysis(PD) by analysing the clinical data of pediatric PD performed in Korea. Methods : 264 cases of CAPD and acute PD had been performed from Nov.1987 to Oct. 1997 in 17 institutions of pediatric nephrology in Korea. Results : CAPD was performed in 114 cases. The mean age of the patients was $10.5{\pm}6.6$ years and male to female ratio was 1.4:1. The original renal diseases of ESRD were proven in 92 cases($80\%$). The common renal disease of ESRD were FSGS($17\%$), reflux nephropathy ($11\%$), chronic glomerulonephritis($9.6\%$). Mean duration of CAPD was $20{\pm}16.9$ months. Peritonitis was the most common complication and incidence was one episode/18.2 patient-months. Other complications were exit site infection in 10 cases, obstruction in 7 cases, leakage of dialysate in 6 cases. The most common etiologic organism of peritonitis was staphylococcus aureus and the next was staphylococcus coagulase(-). Acute PD was performed in 150 cases. Most common underlying causes were congenital heart disease, hemolytic uremic syndrome, sepsis and dehydration. The mean duration was $10.3{\pm}11.3$ days. The most common complication was peritonitis($20.6\%$). The most common etiologic organism was staphylococcus aureus and coagulase(-), acinetobactor and pseudomonas. Conclusion : Reflux nephropathy should be emphasized in early diagnosis and treatment to prevent ESRD. Incidence of congenital anomaly($7\%$) as a original disease of ESRD was relatively low in Korea. Growth status was not significantly improved after CAPD. In acute PD, the incidence of peritonitis was rapidly increased at 2weeks after beginning of dialysis.

• Clinical and Experimental Pediatrics
• /
• v.45 no.5
• /
• pp.615-621
• /
• 2002

Purpose : The neonatal cardiac catheterization and angiogram for transcatheter therapy are still essential methods in congenital heart disease, so we reviewed our experience with neonatal cardiac catheterization over 10 years at a single institution. Methods : A retrospective review of all 139 neonatal catheterizations from January 1991 to December 2000 at Sejong Heart Institution was performed. The purpose of the catheterizations, ages, body weights and the complications by the exam was surveyed. Results : The mean age of our 139 patients was 14.9 days and the mean body weight was 3.3 kg. As for the diagnosis : TGA in 49 patients, PAIVS in 26 patients, DORV in 14 patients, PS in 14 patients, PAVSD in 11 patients. For the cardiac catheterization, general anesthesia was performed in 65% of total and fluoroscopy time was $20.1{\pm}14.5$ minutes during cardiac catheterization. In the interventional cardiac catheterization which was 75% of the total, the age and body weight were statistically the same but the irradiation time was longer than the diagnostic catheterization( P=0.001). There were 48 cases of atrial septostomy, 16 cases of balloon pulmonary valvuloplasty and 25 cases of transcatheter pulmonary valvotomy. Complications of cardiac catheterization were found in 16.3%, but there was no difference between interventional catheterization and diagnostic catheterization. Conclusion : Therapeutic cardiac catheterization in neonates is a relatively safe and effective method in congenital heart disease.

• Journal of Hospice and Palliative Care
• /
• v.22 no.1
• /
• pp.8-18
• /
• 2019

Purpose: This study was conducted to better understand the illness experiences and palliative care needs in community-dwelling persons with cardiometabolic diseases. Methods: This qualitative descriptive study was conducted with 11 patients (and three family members) among 28 patients contacted. Interviews were led by the principal investigator in her office or at participants' home depending on their preference. All interviews were digitally recorded and transcribed by a research assistant. The interviews were analyzed by two independent researchers using a conventional method. Results: Participants' ages ranged from 42 to 82 years (nine men and two women). Three themes were identified: (1) same disease, but different illness experiences; (2) I am in charge of my disease(s); (3) preparation for disease progression. Participants were informed of the name of their disease when they were diagnosed, but not provided with explanation of the diagnosis or meant or how to do self-care to delay the disease progression, which increased the feelings of uncertainty, hopelessness and anxiety. Taking medication was considered to be the primary treatment option and self-care a supplemental one. Advanced care plans were considered when they felt the progression of their disease(s) while refraining from sharing it with their family or health care professionals to save their concerns. All participants were willing to withhold life-sustaining treatment without making any preparation in writing. Conclusion: Education on self-care and advanced care planning should be provided to community-dwelling persons with cardiometabolic diseases. A patient-centered education program needs to be developed for this population.

• Journal of Korean Society of Neurocognitive Rehabilitation
• /
• v.10 no.2
• /
• pp.53-62
• /
• 2018

The purpose of this study was to propose an alternative for the eating habits of modern people and coping with the diseases. The purpose of this study was to apply the principles of eating habits of people living in Roma Linda to modern dietary life and to help healthy life and prevent disease. The period of this study was from May 1, 2016 to February 28, 2018. Literature search was conducted using Pubmed and Korean academic web sites. Based on the recognition of wrong eating habits, we classify and classify diseases according to eating habits. A total of more than 100 papers were selected and 60 papers and a database were prepared. People living in Roma Linda have eight health principles. The Roma Linda practiced balanced nutritional intake, sufficient exercise, adequate water intake, sunlight, temperance (abstinence from alcohol etc.), fresh air, adequate rest, and trust in eating habits. People living in Roma Linda have a high intake of vegetables, fruits and nuts. People living in Roma Linda are educated about nutrition, and among them, there is a low prevalence of coronary heart disease and cancer, because they mostly do not smoke or drink alcohol. Unhealthy eating habits and dietary behavior are associated with many diseases. Many chronic, degenerative diseases are due to bad eating habits and stress. If you take good food habits of people living in the Roma Linda area and practice it steadily, it will have a great effect on disease prevention.

• Journal of Chest Surgery
• /
• v.34 no.11
• /
• pp.831-842
• /
• 2001

Background: Patients with cardiac diseases who have structural defects in their heart bring about metabolic insult such as preoperative acid-base imbalance. Cardiac operation requires many nonphysiologic procedures such as extracorporeal circulation, hypothermia, and hemodilution. We studied the acid-base status of surgical heart diseases pre-operatively, during extracorporeal circulation, and post-operatively and researched the treatment indications of acid-base disturbances. Material and Method: From January 1997 to May 1999, fifty two cases of open heart surgery were carried out under extracorporeal circulation, which divided into a set of pediatric and adult groups, congenital and acquired groups, non-cyanotic and cyanotic groups, The $\alpha$ -stat arterial blood gas analysis was done in each group during the preoperative period, during the operation with extracorporeal circulation, and during the postoperative period. Result: Before surgery, all patients present metabolic acidosis, PaO2 was low in adult group and acquired group and compensatory respiratory alkalosis was noted in cyanotic group. During extracorporeal circulation, adult group revealed alkalosis and normal in acquired group. Pediatric group presents low Pa$CO_2$, metabolic acidosis and respiratory alkalosis. Congenital group and non-cyanotic group showed non-compensatory alkalosis trend and non-compensatory respiratory acidosis were observed in cyanotic group during extracorporeal circulation. Postoperative acid-base status of adult group was recovered to normal and the standard bicarbonate was increased in the acquired group. All of the pediatric, congenital non-cyanotic, and cyanotic groups revealed the lack of buffer base.

• Journal of Chest Surgery
• /
• v.38 no.5 s.250
• /
• pp.335-348
• /
• 2005

Background: This retrospective review examines the preoperative condition, postoperative course, mortality and cause of death for the patients who underwent modified Blalock-Taussig shunt for complex congenital heart defects in early infancy. Material and Method: Fifty eight patients underwent modified Blalock-Taussig shunts from January 2000 to November 2003. The mean age at operation was $23.1\pm16.2$ days ($5\~81\;days$), and the mean body weight was $3.4\pm0.7\;kg\;(2.1\~4.3\;kg)$. Indications for surgery were pulmonary atresia with ventricular septal defect in 12 cases, pulmonary atresia with intact ventricular septum in 17, single ventricle (SV) in 18, and hypoplastic left heart syndrome (HLHS) in 11. Total anomalous pulmonary venous return (TAPVR) was associated with SV in 4 cases. Result: There were 11 ($19.0\%$) early, and 5 ($10.6\%$) late deaths. Causes of early death included low cardiac output in 9, arrhythmia in 1, and multiorgan failure in 1. Late deaths resulted from pneumonia in 2, hypoxia in 1, and sepsis in 1. Risk factors influencing mortality were preoperative pulmonary hypertension, metabolic acidosis, use of cardiopulmonary bypass, HLHS and TAPVR. Twenty four patients ($41.4\%$) had hemodynamic instability during the 48 postoperative-hours. Six patients underwent shunt revision for occlusion, and 1 shunt division for pulmonary overflow. Conclusion: Modified Blalock-Taussig shunt for complex congenital heart defects in early infancy had satisfactory results except in high risk groups. Many patients had early postoperative hemodynamic instability, which means that continuous close observation and management are mandatory in this period. Aggressive management may appear warranted based on understanding of hemodynamic changes for high risk groups.

• Proceedings of the Korean Society for Food Science of Animal Resources Conference
• /
• 1995.11a
• /
• pp.49-70
• /
• 1995

콜레스테롤은 성호르몬, 스테로이드 호르몬, 비타민 D, 담즙산 및 다른 체내화합물에 존재하는 생명에 필수적인 물질이며, 특히 세포막에는 이의 안정적인 기능수행을 위해 일정량의 콜레스테롤이 반드시 존재해야 한다. 이러한 중요성 때문에 우리의 몸안에는 완전히 음식물의 섭취에 의한 공급에 의존하지 않고서도 필요에 따라 체조직의 온전한 기능수행을 위해 즉시 이용될 수 있는 충분한 양의 콜레스테롤이 존재한다. 따라서 체내에서 자체적으로 합성되는 콜레스테롤의 양은 음식물을 통해 흡수되는 양보다 일반적으로 훨씬 높다. 매일 우리의 체내에서는 약 1,500mg 정도의 콜레스테롤이 합성되는데, 주로 간세포에서 만들어지며, 소장세포에서도 일부 합성이 이루어진다. 식단(食單)의 구성에 따라 물론 차이는 있으나, 우리가 매일 음식물을 통해 섭취하는 콜레스테롤의 양은 평균 300~700mg 정도이다 .이중 소장을 통해 흡수될 수 있는 양은 50% 정도에 불과하여 대부분 식사를 통해 흡수되는 콜레스테롤의 양은 실제적인 의미에서 그리 큰 비중을 차지하지 않는다. 대부분의 건강한 사람은 혈액내 콜레스테롤의 수준이 항상 정상적인 범위내에서 유지될 수 있도록 기능적인 체내 Feed-back 기작을 유지하고 있다. 음식물을 통한 식이(食餌)콜레스테롤의 섭취량이 많을 경우에는 이 물질의 장관(腸管)내 흡수율이 낮아지고, 체내 콜레스테롤의 합성량 역시 저하된다. 이러한 방법으로 대부분의 건강한 사람은 음식물을 통한 많은 양의 식이 콜레스테롤 섭취에 대해 효율적으로 보상하는 체내기작을 갖게 되어 혈중 콜레스테롤 수준이 필요 이상 높아지는 것을 막게 된다. 물로 s이러한 보상작용(補償作用)은 사람에 따라 일정하지는 않다. 최근의 연구결과에 의하면, 건강한 사람들의 약 60%정도는 하루에 3개 정도의 달걀에 포함되어 있는 양 정도의 콜레스테롤을 추가적으로 보상시킬 수 있다고 하는데, 이는 달걀 이외의 음식물에서도 섭취되는 콜레스테롤 양을 감안할 때 하루 총 1,000~1,500mg에 해당하는 양이다. 뿐만 아니라 이중 일부 사람들은 일반적인 식단 하에서 6개의 달걀을 추가하여 섭취하여도 혈중 콜레스테롤 수준이 높아지지 않는다고 한다. 여러 나라에서 아직도 일률적으로 권장되는, 음식물을 통한 일당 콜레스테롤 섭취량을 최고 300mg으로 제한해야 한다는 것은 건강인에 있어서는 앞에서 언급한 바와 같은 생리적인 피이드-백 기작으로 말미암아 혈중 콜레스테롤 수준을 저하시키지 못하거나 미미한 정도에 불과하다. 혈중 콜레스테롤 수준이 정상적인 범위인 180~240 mg/dl에 해당하는 대부분의 건강인에게도 콜레스테롤이 많이 함유된 달걀이나 기타 축산물을 이용한 식품의 지속적인 섭취를 적극 피하도록 권장하는 것은 국민보건상 별로 큰 위미가 없다고 생각한다. 왜냐하면 이로 말미암아 국민 건강상 문제점이 크게 향상되었다는 연구보고는 아직 발견되지 않고 있기 때문이다. 더욱이 동물성 콜레스테롤 다량 함유식품인 달걀, 우유, 유제품 및 육류 등의 섭취를 꺼리게 되면 이들 식품들이 영양생리학상 매우 중요한 양질의 영양소를 많이 함유하고 있기 때문에 여러 중요한 필수 영양소의 공급상태를 뚜렷히 감소시키게 된다. 병적으로 혈중 콜레스테롤의 수준이 높은 사람은 관상성 심장병의 발병 내지는 심장경색에 의한 사망에 대한 통계학적 위험성이 증가된다. 고콜레스테롤 혈증(청, 중년층의 경우 260mg /dl 이상) 환자중 많은 사람들은 대부분 음식물을 통한 다량의 콜레스테롤 섭취에 의해 혈중 콜레스테롤 수준이 높아진 것이 아니고, 주로 유전적인 콜레스테롤 대사 결함에 그 원인이 있다고 한다. 이런 환자들의 경우에는 콜레스테롤 및 지방함량이 낮은 음식물만 계속적으로 섭취한다고해서 혈중 콜레스테롤의 수준을 만족할만한 정도까지 낮출 수 있는 것은 아니기 때문에 주로 의학적 약물투여에 의한 치료법을 적용한다. 식이성 고콜레스테롤 증상을 보이는 사람들에 있어서는 음식물의 섭취방법을 조절해 줄 필요가 있는데, 가장 효과적인 식이요법은 체중을 정상적인 수준으로 조절하는데 있다. 이러한 환자의 경우는 지방을 통한 열량 섭취량을 총열량의 30% 정도 수준까지 감소시키는 것이 좋으며, 팔미틴산의 함량이 높은 지방의 섭취는 가능하면 삼가는 것이 좋다. 단순 및 고도 불포화지방산의 함량이 높은 지방의 섭취는 혈중 콜레스테롤의 수준을 한 포인트 정도 낮추는데 추가적으로 기여할 수 있다. 최근의 연구에 의하면, 단순 불포화 지방산인 올레인산을 많이 함유하고 있는 올리브 기름이 특히 혈중 콜레스테롤 수준에 대한 유리한 효과를 나타낸다고 하는데, 이는 오로지 혈액내 LDL-Cholesterol을 감소시키는 작용에 기인한다. 이에 반해 고도 불포화지방산인 리놀산은 저밀도지단백질 부분 외에도 심장 보호성(心臟 保護性) HDL-부분까지도 저하시키게 된다. 따라서 특수하게 리놀산을 강화시켜 제조한 마아가린이나 이와 유사한 기름을 이용한 리놀산 강화식품의 섭취는 이러한 이유 외에도 일정한 부작용이 알려져 있어 더 이상 강하게 추천되지 않고 있다. 만일 이러한 식이조절에도 불구하고 혈중 콜레스테롤 수준이 원하는 정도까지 떨어지지 않을 경우, 물론 콜레스테롤의 섭취를 최저로 제한할 수 있는 방법을 꾸준히 시도해 봐야 하나 일반적으로 미미한 정도의 효과만을 가져온다. 유전 및 식이와 관계되는 사항 외에도 추가적으로 고려해야 할 점은, 혈중 콜레스테롤 수준은 나이, 성별, 스포츠, 흡연, 스트레스 및 음주 등과 같은 요인에도 결정적인 영향을 받는다는 사실이다. 물론 현재까지 과도하게 증가된 혈중 콜레스테롤 수준을 저하시킴으로써 전체 국민의 사망률을 현저하게 낮추고 평균수명을 연장시켰다는 증거는 발견되지 않고 있다. 왜냐하면 단독 식이 요법을 통한 해당 연구들이 현재까지 뚜렷한 긍정적인 결과를 제시하지 못하고 있기 때문이다. 의약품의 투여로 심장경색 및 이로 인한 사망을 감소시킬 수 있었다는 보고는 여러 연구결과들에서 보여주고 있으나, 그대신 다른 질병 및 암에 의한 사망률 역시 동시에 증가되었다고 한다. 이러한 이유로 말미암아 콜레스테롤 저하요법에 있어서 본래의 치료목적 이외의 위험성에도 항상 주의해야할 필요성이 존재한다는 사실을 주지해야 한다.