• Journal of Chest Surgery
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• v.43 no.6
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• pp.619-626
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• 2010

Background: The indications and the optimal time of surgery of infective endocarditis are controversial. We report the surgical results of our hospital during the last 10 years with literature review. Material and Method: Between January 2000 and December 2009, we enrolled 23 infective endocarditis patients who underwent surgery, and analyzed retrospectively. In the preoperative blood culture, 8 cases (34.8%) were positive. The average preoperative antibiotics treatment period was $20.78{\pm}16.00$ days. There were 12 (52.2%) urgent operations. The average follow up period was $49.26{\pm}33.21$ months. Result: 20 mechanical valve replacements were performed, 9 in aortic position, 8 in mitral position and 3 in the both positions. The other procedures were one mitral valvuloplasty, one infected myxoma extirpation, and one infected pacemaker lead removal with debridement. The average period of postoperative intravenous antibiotic treatment was $24.39{\pm}15.98$ days. There were 5 complications, including 2 cases of postoperative bleeding, one postcardiotomy syndrome, one cerebral ischemia, and a low cardiac output syndrome. There were statistically significant postoperative improvement in NYHA class, left ventricle end diastolic/end systolic volume, and left atrium size (p-value < 0.05). Conclusion: We could obtain the satisfactory results without any moftalities by using sufficient preoperative antibiotics in hemodynamically stable patients, and by prompt surgery in unstable patients.

• Restorative Dentistry and Endodontics
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• v.29 no.5
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• pp.479-484
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• 2004

Immunoinhibitory protein extracted from sonicated Treponema denticola have been shown to suppress cell cycle progression of human lymphocytes. To study in detail about the effect of this microorganism on the function of lymphocytes. we investigated the levels of Interleukin-2 (IL-2) and Interleukin-4 (IL-4) production by T lymphocytes before and after the addition of $12.5{\;}\mu\textrm{g}/ml$ T. denticola sonicated extracts. In this study. levels of IL-2 and IL-4 produced from T cells pretreated with sonicated extracts were evaluated by using the quantitative sandwich enzyme immunoassay technique. In response to phytohemagglutinin (PHA) stimulation. T cell produced increased levels of IL-2 and IL-4. However. the expressions of both cytokines were significantly inhibited when PHA activated-T cells were pre-exposed to sonicated T. denticola extracts (p < 0.05). These findings suggest that the T. denticola sonicated extracts induced-immunosuppression in Th1 and Th2 cell functions could be a part of the pathogenic mechanism of the endodontic failure associated with this microorganism.

• Neonatal Medicine
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• v.18 no.2
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• pp.320-327
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• 2011

Purpose: To determine the effect of changing practice guidelines designed to avoid hyperoxia or hypoxia in very low birth weight or very preterm infants. Methods: We analyzed a database of <1,500 g birth weight or <32 weeks of gestation infants who were born and admitted to the neonatal intensive care unit of Chungnam National University Hospital from January 2007 to July 2010. First, we defined the relationship between arterial partial pressure of oxygen ($PaO_2$) and pulse oxygen saturation ($SpO_2$). When we evaluated 96 pairs of $PaO_2$ and $SpO_2$ measurements, oxygen saturation was 90-94% at a $PaO_2$ of 43-79 mmHg on the oxyhemoglobin dissociation curve, according to pulse oximetry. Based on this observation, a change in practice was instituted in August 2008 with the objective of avoiding hypoxia and hyperoxia in preterm infants with targeting a $SpO_2$ 90-94% (period II). Before the change in practice, high alarms for $SpO_2$ were set at 100% and low alarms at 95% (period I). Results: Sixty-eight infants the met enrollment criteria and 38 (56%) were born during period II, after the change in $SpO_2$ targets. Demographic characteristics, except gender, were similar between the infants born in both periods. After correcting for the effect of confounding factors, the rates for mortality, severe retinopathy of prematurity, and IVH attended to be lower than those for infants in period II. No difference in the rate of patent ductus arteriosus needed to treat was observed. Conclusion: A change in the practice guidelines aimed at avoiding low oxygen saturation and hyperoxia did not increase neonatal complication rates and showed promising results, suggesting decreased mortality and improvements in short term morbidity. It is still unclear what range of oxygen saturation is appropriate for very preterm infants but the more careful saturation targeting guideline should be considered to prevent hypoxemic events and hyperoxia.

• Pediatric Infection and Vaccine
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• v.23 no.2
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• pp.128-136
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• 2016

Purpose: This study was done to define clinical characteristics of fever without localizing signs (FWLS) in infants younger than 100 days of age with a goal of providing baseline data to establish a new diagnostic paradigm in the future. Methods: We reviewed medical records of 183 patients who admitted to Daegu Catholic University Medical Center for FWLS younger than 100 days of age from January 2013 to September 2015 retrospectively. Demographic, clinical features and laboratory findings were analyzed. Patients were divided into serious bacterial infection (SBI) and non-SBI groups, and then were compared between two groups to find risk factors for SBI. Results: Among 183 patients, lumbar puncture was performed in 98.9% and CSF pleocytosis was present in 35.9%. Sterile CSF pleocytosis was found in 43% of urinary tract infection (UTI) patients. None had concomitant bacterial meningitis in patients with UTI. As final diagnosis, febrile syndrome without source (25.7%) was most common. Among SBI, UTI was most common (99%). Birth weight, ESR, and CRP were significantly higher in SBI group compared to non-SBI group. Male sex (OR 4.93, 95% CI 1.60-15.24) and pyuria (OR 18.88, 95% CI 6.76-52.76) were identified as risk factors for SBI. Presence of sibling (OR 0.30, 95% CI 0.11-0.83) was significantly lower in SBI group. Conclusions: Our results showed UTI was the most common SBI in young infants with FWLS. Though aseptic meningitis can be coexisting with UTI, lumbar puncture may not be necessary in all patients having UTI.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.735-741
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• 2004

Blood cardioplegia is known as an established cardioplegic solution during open heart surgery. Recently, the Histidine-Tryptophan-Ketoglutarate (HTK) solution has been introduced as a cardioplegia in Korea. This study was designed to compare the myocardial protective effect between the cold blood cardioplegia (CBC) and HTK solution. Material and Method: Forty patients who underwent valve surgery or coronary artery bypass surgery were randomly divided into CBC group (n=20) and HTK group (n=20). The perioperative hemodynamic and clinical data were analyzed. The concentration of CK-MB, Troponin 1 and Lactate from coronary sinus and radial arterial blood were compared for the evaluation of the myocardial damage. The postoperative serial CK-MB levels were measured. Result: The characteristics of preoperative patients were similar in two groups. The hemodynamic parameters and postoperative clinical data were also similar between the two groups. There were no statistical significances between the CBC and HTK group in the difference of biochemical markers: Δ CK-MB (15.3$\pm$26.0 vs 19.3$\pm$14.3), ΔTro-1 (2.4$\pm$4.9 vs 2.0$\pm$2.20), ΔLac (1.6$\pm$1.0 vs 1.9$\pm$2.5). The serial CK-MB levels were not significantly different between the two groups. Conclusion: These results suggested that the myocardial protective effect of HTK solution was similar to cold blood cardioplegia during open heart surgery.

• Clinical and Experimental Pediatrics
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• v.49 no.5
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• pp.500-506
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• 2006

Purpose : We evaluated an outbreak of Serratia marcescens infections in 24 neonates in a neonatal intensive care unit(NICU). Methods : From January to August, 2004 a nosocomial outbreak of S. marcescens occurred in our NICU. We describe the clinical characteristics of the outbreak and analyse the risk factors for infections with S. marcescens. After the outbreak stopped, 7 isolates from blood were typed using rapid amplified polymorphic DNA analysis(RAPD). Results : S. marcescens was isolated from 24 neonates, 19 infected and 5 colonized. Seven out of nineteen neonates had bacteremia, 4 had ventilator associated pneumonia, 4 had purulent conjunctivitis, 2 had UTI, 1 had meningitis and 1 had a wound infection. Three neonates died due to S. marcescens infection, 2 of 3 had ventilator associated pneumonia, 1 had meningitis complicated with abscess. The mortality rate of S. marcescens infection was 15.8%. Factors associated with S. marcescens infections were previous antibiotic therapy, indwelling catheter and use of ventilators. The isolated strains were resistant to most antibiotics, but frequently sensitive to imipenem, bactrim and amikacin. RAPD typing results show that at least 3 epidemic strains were related with this outbreak. But one genotype was predominant type in this outbreak. The control measures were instituted and the outbreak stopped within 2 months. Conclusion : S. marcescens can cause rapidly spreading outbreaks associated with fatal infections in neonates. If S. marcescens is isolated from clinical specimens, meticulous infection control measures and epidemiologic investigations should be done at an early stage of the outbreak.

• Clinical and Experimental Pediatrics
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• v.51 no.6
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• pp.616-621
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• 2008

Purpose : This study was undertaken to identify factors that influence 17-OHP levels in preterm infants and to suggest a reasonable follow-up schedule of screening for congenital adrenal hyperplasia (CAH) in preterm infants. Methods : The 17-OHP concentrations in filter paper blood spots of 427 preterm infants were obtained. The effects of gestational age (GA), systemic diseases, and antenatal dexamethasone on screening and follow-up 17-OHP values were investigated. Results : The screening 17-OHP values were markedly variable (range: 0.1-143.3 ng/mL). The screening 17-OHP levels were negatively correlated with GA (r=-0.535, P<0.01). In infants with GA<32 weeks, the screening 17-OHP levels were significantly higher in sick infants or infant with hypotension than in healthy infants. The screening values of prenatal dexamethasone-treated infants had a tendency to be low. In infants with initial 17-OHP values ${\geq}20ng/mL$, the intervals until rescreening 17-OHP <10 ng/mL or serum 17-OHP <20 ng/mL were negatively correlated with GA (r=-0.541, P<0.01) and were prolonged in infants with bronchopulmonary dysplasia (P<0.01). None of the preterm infants were confirmatively diagnosed with CAH. Conclusion : The 17-OHP values of preterm infants were influenced by GA, prenatal dexamethasone, and postnatal diseases. Because the 17-OHP values of preterm infants were markedly variable, a follow-up schedule should be developed considering both 17-OHP values and clinical status.

• The Korean Journal of Nuclear Medicine
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• v.4 no.1
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• pp.1-9
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• 1970

철대사(鐵代謝)에 관(關)한 연구(硏究)는 과거(過去) 30년(年)동안 새로운 검사방법(檢査方法)의 도입(導入)으로 눈부신 발전(發展)을이룩하였다. 1937년(年) Heilmeyer 등(等)에 의(依)하여 Ortho-phenanthrolin방법(方法)의 개발(開發)로 저색소성빈혈(低色素性貧血)의 원인(原因)이 구명(究明)되고 또한 이에 대(對)한 치료(治療)의 원칙(原則)이 세워졌다. 그 후 심(甚)한 감염(感染)이나 악성종양(惡性腫瘍)을 가진 환자(患者)者에서 관찰(觀察)되는 빈혈(貧血)에 대(對)해서 하나의 가설(假說)을 세워 이를 설명(說明)하려 하였는데 이는 곧 혈장(血漿)으로부터 철분(鐵分)이 신속(迅速)히 소실(消失)되어 망내계(網內系)나 병변(病變)이 있는 국소부위(局所部位)에 주(主)로 모여 들어 특수(特殊)한 방어기능(防禦機能)을 발휘(發揮)한다는것으로 연자(演者)는 방사성동위원소(放射性同位元素)를 이용(利用)하여 이 가설(假說)을 증명(證明)하였으며 이 연구(硏究)에는 또한 이문호교수(李文鎬敎授)가 Freiburg대학(大學) 유학중(留學中) 참여(參與)한 바 있다. 철대사(鐵代謝)를 파악(把握)하기 위(爲)해서 $^{59}Fe$가 흔히 사용(使用)되는데 이러한 방사성동위원소(放射性同位元素)를 이용(利用)함으로서 다음 사항(事項)들을 관찰(觀察)할 수 있었다. 즉(卽) 1. 소화장기(消化臟器)로 부터의 철흡수(鐵吸收) 2. 혈장(血漿)에서의 철(鐵)의 소실속도(消失速度) 3. 혈장내(血漿內)에서의 철교체율(鐵交替率) 4. 적혈구(赤血球)의 철이용(鐵利用) 5. 생체내(生體內)의 철분포(鐵分布) 6. 철배설(鐵排泄)의 정량적(定量的) 분석(分析) 또한 근년(近年)에는 특수(特殊)한 기능(機能)을 발휘(發揮)할 수 있는 동위원소(同位元素)를 이용(利用)하여 철흡수(鐵吸收) 및 대사이외(代謝以外)에도 적혈구(赤血球)의 수명(壽命)과 혈액량등(血液量等)을 측정(測定)하게 되었다. 경구적(經口的)으로 투여(投與)된 철(鐵)은 대부분(大部分) 십이지장(十二指腸)의 상부(上部)에서 흡수(吸收)되고 무기철(無機鐵)이 보다 쉽게 흡수(吸收)되어 가(價)의 상태(狀態)로 된다. 혈장(血漿)에서는 transferrin에 의(依)해서 철(鐵)이 운반(運搬)된다. 혈장철(血漿鐵)의 대부분(大部分)은 혈색소분해(血色素分解)에서 유래(由來)되며 이는 다시 혈색소(血色素)의 재생(再生)에 이용(利用)되는데 혈장내(血漿內) 철교체율(鐵交替率)은 방사성철(放射性鐵)을 이용(利用)하여 측정(測定)할수 있다 이와같이 방사성철(放射性鐵)을 이용(利用)하여 철대사과정(鐵代謝過程)을 숙지(熟知)함으르서 임상(臨床)에 응용(應用)하기에 이르렀으며 다음과 같은 질환(疾患)의 진단(診斷)에 특(特)히 큰 도움을 준다. A. 진성철결핍증(眞性鐵缺乏症) : 혁색소철(血色素鐵) 및 저장철(貯藏鐵)을 포함(包含)한 생체내(生體內) 전철분(全鐵分)의 부족(不足)된 상태(狀態)로서 실혈(朱血)에 의(依)한 것이 대부분(大部分)이다. 이 경우 철흡수(鐵吸收)는 증가(增加), 혈장철치(血漿鐵値)는 저하(低下), 철소실속도(鐵消失速度)는 증가(增加)되며 혈장철(血漿鐵) 교체율(交替率)은 항진(亢進) 혹(或)은 정상(正常)이다. B. 심(甚)한 염증성(炎症性) 질환(疾患) : 이 경우에도 혈장철치(血漿鐵値)의 저하(低下), 소실속도(消失速度)의 증가(增加), 교체율(交替率)은 정상(正常)보다 4배(倍)까지 증가(增加)할 수 있다. 골수(骨髓)에서 보다는 간(肝), 비(脾)와 같은 망내계(網內系)에 방사성철(放射性鐵)이 집결(集結)되는 것으로 보아 혈색소철(血色素鐵)보다는 저장철(貯藏鐵)이 관여(關與)되는 것이다. C. 원발성(原發性) 혈색소증(血色素症)(Idiopathic hemochromatosis) : 혈장철(血漿鐵)의 증가(增加)가 현저(顯著)하며 transferrin 농도(濃度)는 정상(正常)보다 낮으나 거의 대부분(大部分)의 철분(鐵分)으로 포화(飽和)된다. 철흡수(鐵吸收)는 증가(增加)되고 철소실속도(鐵消失速度)는 감소(減少) 되어 있으나 교체율(交替率)은 항진(亢進)되어 있다. 혈장철(血漿鐵)은 간(肝), 비(脾) 등(等)의 기관(器管)으로 저장집결(貯藏集結)되어 철저류(鐵貯溜)가 증대(增大)되므로 철이용증((鐵利用症)은 저하(低下)된다. D. 선천성(先天性) 무(無)$\ulcorner$트란스헤 린$\lrcorner$증(症)(Congenital atransferrinemia) : 방사성철(放射性鐵)을 이용(利用)한 진단방법(診斷方法)으로 Freiburg에서 7세(歲)의 소녀(少女)에서 발견(發見)한 증례(症例)인데 간(肝), 비(脾), 심(心)의 비대(肥大)가 임상적(臨床的)으로 인지(認知)되었고 중증(重症)의 철결핍상(鐵缺乏狀)을 검출(檢出)할 수 있었다. 철흡수율(鐵吸收率)의 상승(上昇), 혈장철치(血裝鐵値)의 감소(減少), 혈장철소실속도(血漿鐵消失速度)의 증가(增加), 혈장철교체율(血漿鐵交替率)의 상승(上昇) 및 적혈구(赤血球)에서의 철분이용율(鐵分利用率)의 저하(低下)를 ferrokinetic study에서 알 수 있었고 간(肝)에서 고도(高度)의 방사능(放射能)이 검출(檢出)되는 반면(反面), 비(脾)에서는 극소(極小), 골수(骨髓)에는 전(全)혀 방사능(放射能)이 들어가 있지 않았다. 이 증례(症例)와 같이 transferrin이 없으면 철분(鐵分)은 쉽게 조직(組織)으로 들어가 hemosiderin으로 저장(貯藏)되고 골수(骨髓)는 고도(高度)의 철결핍증(鐵缺乏症)을 나타내어 기관철침착증(器管鐵沈着症)과 철결핍성빈혈(鐵缺乏性貧血)이 동시(同時)에 나타나게 된다. 철대사장애면(鐵代謝障碍面)으로 보아 많은 미해결점(未解決點)이 남아 있으며 앞으로 자라나는 젊은 학도(學徒)들이 구명(究明)할 문제(間題)라고 믿는다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.2
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• pp.164-171
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• 2010

Purpose: Iron deficiency anemia (IDA) is one of the most common nutritional problems, despite a recent improvement of nutritional status of infants and children. We assessed the risk factors for IDA in infants and vitamin D deficiency and IDA by nutrition analysis. Methods: We analyzed blood tests and evaluated 103 children with IDA and 123 children without IDA, 6-36 months of age, who were cared for in our hospital between March 2006 and July 2010. Nutritional analysis using Canpro was performed among breastfed infants 6~12 months of age who had been diagnosed with IDA and had detailed diet histories. Results: Breastfed infants accounted for 87.4% and 40.7% of the IDA and comparison groups, respectively. The IDA and comparison groups began weaning food at 6.4${\pm}$1.8 and 5.9${\pm}$1.3 months, respectively. In the IDA and comparison groups, 46.4% and 53.5% began to adapt to weaning food within 4 weeks, respectively. The most common reason for hospital care of the IDA group was respiratory symptoms constituting 36.2%. Only 18.6% visited the hospital for palloror anemia. The Canpro analysis, performed on 11 infants with IDA, showed that iron and vitamin D were <40% and 30% of recommended intakes, respectively. Conclusion: Weaning food should be started 4~6 months of age in breastfed infants. In infants at high risk for IDA and vitamin D deficiency, screening tests should be recommended. The high-risk infants may require iron, vitamin D fortified formula, or oral supplements.

• Pediatric Infection and Vaccine
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• v.10 no.1
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• pp.81-86
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• 2003

Purpose : Streptococcus pneumoniae remains a leading cause of meningitis, sepsis, pneumonia, and otitis media in children worldwide. Emergence of drug-resistant organism has substantially complicated the therapy of these infections. This study was conducted to determine the clinical features and changing patterns of antibiotic-resistant rates of Streptococcus pneumoniae. Methods : We have retrospectively examined 306 cases of culture proven patients who were admitted to the Department of Pediatrics, Severance hospital, from the year 1991 to year 2000. The type of culture specimen used, presence of penicillin resistance, characteristics according to various presenting diseases and their prevailing year were also examined. Results : The mean age of cases was 7.9 year and the ratio of male to female was 1.6 : 1. The main age group of pneumococcal infection was under 2 years(42%). Systemic infections associated with pneumococci were sepsis(19.3%) and meningitis(9.5%), while local infections presented as pneumonia(29.2%), otitis media(19.3%), exudative tonsillitis(13.3%), and sinusitis(9.2%) in the order of frequency. Seasonal variation was seen in the incidence of pneumococcal infection: high incidence of infection was seen in Spring(Mar.~Apr; 32%), while the incidence was low during summer(Aug.~Sep.; 6%). Penicillin-resistant rate of pneumococci was steadily on the increase since the year 1991(65%) to year 2000(84%). Conclusion : Antibiotic-resistant pneumococci increased during the past decade. For effective prevention of pneumococcal infections, national survey of pneumococcal infections and expanded use of pneumococcal vaccination would be needed.