• Journal of Environmental Impact Assessment
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• v.5 no.1
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• pp.47-60
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• 1996

Nitrate contamination problems from groundwater supplies have been reported throughout many countries in the world, including Korea. Nitrate salts can induce methemoglobinemia and possibly human gastric cancer. To reduce human health risk from nitrate in groundwater supplies, several nitrate risk-management strategies can be developed based on the acceptable level of human health risk, the reasonableness of nitrate-control cost, and the technical feasibility of nitrate-control methods. However, due to a lack of available information, assessing risk, cost and technical feasibility contains elements of uncertainty. In the present paper, a nitrate risk-management methodology using fuzzy sets in combination with a multiobjective decision-making (MODM) technique is developed to assist decision makers in evaluating, with uncertain information, various nitrate risk-management strategies in order to decide a proper strategy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.252-256
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• 2005

The combination of Congenital central hypoventilation syndrome with Hirschsprung's disease, also known as Haddad syndrome, belongs to the family of diseases now designated as Neurocristopathies. We have experienced a case of Haddad syndrome in a male infant who presented with repetitive abdominal distension, bilious vomiting, and sleep apnea. Following colon study and rectal biopsy disclosed the absence of the ganglion cell. And the infant could not be weaned from mechanical ventilation since birth because of the absence of effective, spontaneous respiration during sleep. As he was diagnosed as Haddad syndrome, tracheostomy and ileostomy were performed consecutively. At the age of 4 months, he was relatively healthy but remained ventilator-dependent. We report the first Korean case of Haddad syndrome with a brief review of the related literature.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.518-521
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• 2010

A one-day-old baby was transferred for cyanosis and heart murmur. Echocardiographic evaluation revealed that he had severe neonatal Ebstein's anomaly (Carpentier type C), pulmonary atresia, and pulmonary circulation via patent ductus arteriosus. Because the wall of the atrialized right ventricle was very thin, showed decreased contractility, and the small right ventricle showed pulmonary atresia, we decided that a two-ventricular repair was impossible. When the patient was one-month-old, he underwent right atrium reduction-plasty, a right ventricular exclusion procedure (including atrialized right ventricle resection and functional right ventricle plication), and right modified Blalock-Taussig shunt. He was discharged without specific problems. He received a bidirectional cavopulmonary shunt successfully at 4 months later.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.702-706
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• 2004

Pulmonary arteriovenous fistula is usually considered as a subset of congenital anomalies or acquired causes which can produce a variety of conditions such as dyspnea, cyanosis, and pulmonary vascular bruit. The diagnostic methods can be diverse such as arterial blood gas analysis (ABGA), chest X-ray, chest CT and pulmonary angiogram but the most accurate diagnostic modality is thought to be the pulmonary angiogram. The complications of this disease are a rupture that can cause hemothorax, brain abscess, and cardiovascular accident, and the treatment options are either segmental resection or therapeutic embolization. A twenty-six year old female developed sudden dyspnea and visited our emergency room. The patient was diagnosed as having pulmonary arteriovenous fistula (size; 4${\times}$4${\times}$3 cm) in the superior segment of the right lower lobe, evidenced by chest CT and pulmonary angiogram. Consequently, she underwent an emergency right lower lobectomy. We report this rare case of combined hemothorax that we have experienced, from diagnosis to treatment.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.95-97
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• 2008

Ischemic ventricular rupture is one of the most fatal complications following myocardial infarction, and this requires prompt diagnosis and operation. A 75-year-old female was admitted to the ER in a semicomatous mentality with cyanotic extremities. Cardiac echography was carried out in the ER, and a $1.5{\sim}2\;cm$ thickness of effusion in the pericardium was seen. Because the patient's heart had declined to 35 times per min, an emergency operation was started while giving cardiac massage. After observing a 1 cm rupture on the right ventricular wall and a necrotic hemorrhagic scar with a rupture on the left ventricular apical wall, repair of the ruptured areas with a large Satinsky clamp was carried out to control bleeding without cardiopulmonary bypass. On the 28th day after surgery, she was discharged home with a minimal degree of dyspnea.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.696-700
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• 2007

We report here on the midterm results after a Starnes operation for a severely symptomatic neonate with Ebstein's anomaly. A one-day-old baby presented with cyanosis and severe cardiomegaly. We peformed patch closure of the tricuspid valve with a central shunt after failure of tricuspid valve repair with vertical plication of the atrialized ventricle at her age of 19 days. The coronary sinus was drained into the right ventricle. She underwent bidirectional cavopulmonary shunt and extracardiac conduit Fontan operation at her age of 16 and 30 months, respectively. She is now 56 months old and is doing very well. The recent follow-up study revealed that she was in normal sinus rhythm and had a normal sized left ventricle with good function and the small right ventricle without thrombus formation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.3
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• pp.237-245
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• 2004

The deformities of micrognathia and glossoptosis in the newborn are frequently associated with a cleft palate, which is known as Pierre Robin sequence. Upper airway obstruction is the most serious problem in these patients. Treatment of Pierre Robin sequence includes either positional or surgical intervention. Mild cases are often managed in the prone position. However, when the patient fails to thrive due to chronic upper airway obstruction, or severe respiratory distress ensures despite positional treatment, surgical intervention is mandatory to relieve the obstruction. We experienced three infants with Pierre Robin sequence who showed a symptom triad of micrognathia, glossoptosis, and cleft palate. Intermittent cyanosis, depression of the chest, respiratory difficulty and feeding problems were also observed. To relieve severe upper airway obstruction caused by micrognathia and glossoptosis, we simultaneously performed modified tongue lip adhesion (TLA) and a subperiosteal release of the floor of the mouth (SRFM). Respiratory and feeding difficulties were relieved, the tongue positioned anteriorly, body weight increased, and mandibular growth improved. Simultaneous TLA and SRFM may constitute a simple and reliable method for surgical treatment of airway obstruction in patients with Pierre Robin sequence.

• Clinical and Experimental Pediatrics
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• v.45 no.10
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• pp.1298-1301
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• 2002

Systemic capillary leak syndrome(SCLS) is a rare disorder of unknown etiology, which is characterized by recurrent attacks of hypotension, hemoconcentration, and hypoalbuminemia. Urinary or enteric loss of protein is not demonstrated. It is often associated with monoclonal gammopathy, but does not manifest multiple myeloma. Since Clarkson et al. described the first case in a 34-year-old woman, about 50 cases have been reported in the literature. However, most of the cases were of adult age, and the mean age of onset in the reported cases was 42.6 years. In literature review, we could refer only one pediatric case of SCLC by Foeldvari et al. in 1995. We report another pediatric case of SCLS.

• The Journal of Korean Medical History
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• v.27 no.1
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• pp.9-13
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• 2014

연구목적 : 조선(朝鮮) 왕실자녀(王室子女)의 출산과정을 일지(日誌) 형식으로 기록한 "호산청일기(護産廳日記)"는 후기 조선(朝鮮)의 임산(臨産)과 분만, 산후 및 신생아 증상에 대한 의학적 처치 및 산실배설(産室排設)과 출산의례를 고찰할 수 있는 가치 있는 의학사료(醫學史料)이다. 연구방법 : 1. "호산청일기(護産廳日記)"에 기록된 세 번의 출산에 대해 출산 전후 산부(産婦)와 신생아의 실제 상황과 증상, 의관(醫官)의 판단과 치법(治法), 처방(處方)내용, 치료경과 등 의학적 처지의 내용을 살펴봄으로써 당시 산과의학(産科醫學)의 경향성, 발달정도 등을 가늠해보았다. 2. "호산청일기(護産廳日記)"에 기록된 세 번의 출산에 대해 조선왕실(朝鮮王室)의 출산형식 및 관련의례에 드러난 당시 의학의 출산에 대한 의철학(醫哲學)이 어떠하였는지 고찰하였다. 결과 및 결론 : 산전(産前) 의관(醫官)의 정기문진으로 산모와 의사 간 관계형성 및 산부(産婦)의 안정을 도모하였으며, 의녀(醫女)의 진찰소견을 의관(醫官)이 판단하여 처방하였다. 임산(臨産)에 불수산(佛手散)과 인삼차(人蔘茶), 산후어혈증(産後瘀血症)에 가미궁귀탕(加味芎歸湯)을 빈용(頻用)하였으며, 화반곽탕(和飯藿湯)의 식치(食治)가 주요 산후조리법이었다. 신생아의 구급(救急)에 특히 우황(牛黃)을 빈용(頻用)하고 증상에 따라 유모(乳母)가 복약(服藥)하기도 하였으나, 조산(早産)된 신생아의 청색증(靑色症)(cyanosis)으로 보이는 증후(症候)와 사망례(死亡例)가 보인다. 산실배설(産室排設) 및 현초(懸草), 권초제(捲草祭) 등 관련의례에는 출산을 '하늘과 직접 소통하는 하나의 의례(儀禮)'로 생각하여 외부 환경의 방해 없이 산부(産婦)와 신생아의 천계(天癸)가 잘 작동하도록 배려한 의철학(醫哲學)이 드러나 있다.

• Pediatric Infection and Vaccine
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• v.11 no.1
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• pp.112-120
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• 2004

Purpose : Methicillin Resistant-Coagulase Negative Staphylococcus(MR-CNS) infection has become an increasingly important cause of morbidity in NICU infants. We investigated the c linical characteristics of MR-CNS sepsis. Methods : This study included 40 neonates with MR-CNS sepsis who were admitted to the neonatal intensive care unit of Kangnam Sacred Heart Hospital, Hallym University from January 1998 to July 2002. MR-CNS sepsis was defined as MR-CNS recovery from blood with clinical symptoms and signs of infection. Retrospective analyses of the medical records of patients with MR-CNS sepsis were performed. The analyses included demographic findings, clinical features, hospital courses, risk factors for infection including invasive procedures and mortality. Results : From 1998 to 2002, there were 40 cases of MR-CNS sepsis, comprising 17.7% of late onset infections in NICU of Kangnam Sacred Heart Hospital. The male/female ratio was 1.5 : 1. The mean gestational age of infected babies was $32.4{\pm}4.3$ weeks at birth. And the first positive MR-CNS culture was done in the day $10.6{\pm}9.3$ after birth. Clinical symptoms such as fever, dyspnea, cyanosis, grunting, bradycardia, vomiting and diarrhea were frequent in MR-CNS. Mechanical ventilation was applied in 12 cases and catheter was inserted in 11 cases. The mortality(12.5%) directly attributable to MR-CNS sepsis was similar to other late onset infections. Conclusion : MR-CNS is a pathogen responsible for most late onset and nosocomial infections. And it will be life-threatening in high-risk neonate. Awareness of increasing infections due to MR-CNS in NICU is important not only for infection control but also placing a great limit in use of antibiotics and invasive procedures, especially in premature infants.