• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.757-762
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• 2006

Purpose : Pneumonia is one of the most common infections in children who visit emergency departments(ED), but standard clinical guidelines for children with pneumonia in Korea have not been studied. This study was performed to collect and evaluate a data-base of children with pneumonia for establishing clinical guidelines in ED. Methods : This study reviewed 304 children who were diagnosed and treated for pneumonia in the ED at one tertiary hospital between January 2003 and December 2003 retrospectively by reviewing the charts and analyzing the clinical characteristics, laboratory findings, and radiologic findings between an admission group and a discharge group. Results : The 2 year-5 year age group was the top of age distribution and the peak incidence of monthly distribution was December. Two hundred forty seven(81.3 percent) children were hospitalized(admission group), and the mean length of hospitalization was $7.24{\pm}3.24$ days. The most common indications of admission were fever, tachypnea and an age of less than three months. There was statistical differences in the outpatient department follow-up between the two groups(85.8 percent in admission group vs 35.1 percent in discharge group). Conclusion : More prospective studies are needed to establish clinical standard guidelines for children with pneumonia. This will be helpful in ED management and will aid the prevention of pneumonia.

• Clinical and Experimental Pediatrics
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• v.53 no.4
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• pp.592-597
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• 2010

Hyperimmunoglobulin E syndrome (HIES) is a rare immunodeficiency disease which is characterized by high serum IgE levels, eczema, and recurrent infections. Herein we present the case of a patient with HIES associated with STAT3 gene ($stat3$) mutation. A 16 year-old girl was admitted to our hospital due to hemoptysis caused by pneumonia with bronchiectasis. She had a history of recurrent skin and respiratory tract infections, such as pneumonia caused by MRSA (methicillin-resistant $Staphylococcus$ $aureus$) and $Pseudomonas$ $aeruginosa$. On physical examination, a broad round shaped nose, oral thrush, and chronic eczematous skin rash over her whole body were found. Laboratory data showed an elevated eosinophil count ($750/{\mu}L$) and total IgE level (5,001 U/mL). The patient's National Institutes of Health (NIH) score for HIES was 44. Direct sequencing of the STAT3 gene revealed that the patient was heterozygous for a missense mutation in the DNA binding domain of the STAT3 protein (c.1144C>T, p. Arg382Trp). HIES should be suspected in patients with recurrent infections and can be confirmed by clinical scoring and genetic analysis.

• Clinical and Experimental Pediatrics
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• v.50 no.3
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• pp.248-254
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• 2007

Purpose : Inflammation plays a major role in the pathogenesis of RDS and BPD in the immature lung. We investigated the possible role of IL-10 and IL-12 in the cord blood of preterm newborns with RDS or BPD. Methods : Forty preterm newborns whose mothers received antenatal care at Ewha Womans University Mokdong Hospital between January 2003 to June 2005, and agreed to testing their cord blood samples were enrolled. The gestational ages were below 34 weeks. Cord blood level of IL-10 and IL-12 were determined by ELISA. We separated the patients into 2 groups (RDS group and non-RDS group, BPD group and non-BPD group) and compared the cytokine levels and clinical records of the groups. Results : Cord blood IL-10 level showed a significant inverse correlation with gestational age and birth weight (P=0.001, P=0.005). Preterm infants with RDS showed higher IL-10 level (1.0 vs 0.1 pg/mL; P=0.001) in the cord blood than those without RDS. The differences remained statistically significant after correction for the effect of gestational age between both preterm groups. Despite similar cord blood IL-10 levels, preterm infants with BPD showed no significant difference with those without BPD. Conclusion : Cord blood IL-10 levels are increased in preterm infants which may be due to the immuno-suppression occurring during pregnancy and to fetal immaturity because these levels are inversely correlated with the gestational age. So, Cord blood IL-10 level can be used as the predictor of RDS.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.2
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• pp.69-81
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• 2008

Purpose: To reduce side effects in image guided radiation therapy (IGRT) and to improve the quality of life of patients, also to meet accurate SETUP condition for patients, the various SETUP correction conditions were compared and evaluated by using on board imager (OBI) during the SETUP. Materials and Methods: Each 30 cases of the head, the neck, the chest, the belly, and the pelvis in 150 cases of IGRT patients was corrected after confirmation by using OBI at every 2∼3 day. Also, the difference of the SETUP through the skin-marker and the anatomic SETUP through the OBI was evaluated. Results: General SETUP errors (Transverse, Coronal, Sagittal) through the OBI at original SETUP position were Head & Neck: 1.3 mm, Brain: 2 mm, Chest: 3 mm, Abdoman: 3.7 mm, Pelvis: 4 mm. The patients with more that 3 mm in the error range were observed in the correction devices and the patient motions by confirming in treatment room. Moreover, in the case of female patients, the result came from the position of hairs during the Head & Neck, Brain tumor. Therefore, after another SETUP in each cases of over 3 mm in the error range, the treatment was carried out. Mean error values of each parts estimated after the correction were 1 mm for the head, 1.2 mm for the neck, 2.5 mm for the chest, 2.5 mm for the belly, and 2.6 mm for the pelvis. Conclusion: The result showed the correction of SETUP for each treatment through OBI is extremely difficult because of the importance of SETUP in radiation treatment. However, by establishing the average standard of the patients from this research result, the better patient satisfaction and treatment results could be obtained.

• Radiation Oncology Journal
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• v.14 no.4
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• pp.299-306
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• 1996

Purpose : Respiratory symptoms related with malignant airway disease have been the main causes of lowered qualify of life and also sometimes may be life-threatening if not properly managed. The authors report the short-term experiences of endobronchial brachytherapy for symptomatic malignant airway obstruction using high dose rate after-loading brachytherapy unit. Materials and Methdos : Twenty-five Patients with symptomatic malignant airway obstruction were treated with endobronchial brachytherapy between the period of December 1994 and March 1996 at Department of Radiation Oncology of Samsung Medical Center Twenty-one ($84\%$) were patients with non-small cell lung cancer, three with tracheal malignancies, and one with recurrence of esophageal cancer. Twenty Patients were given elective external beam radiation therapy, while six were given endobronchial laser evaporation therapy on emergency bases in addition to endobronchial brachytherapy. Three procedures for each patient were planned and total of 70 procedures were completed. Results : Improvement rates of major respiratory symptoms after endobronchial brachytherapy procedures were $88\%$(22/25). $96\%$(22/23), $100\%$ (15/15), and $100\%$(9/9) for cough, dyspnea, hemoptysis and obstructive pneumonia, respectively. ECOG performance scores were improved in $56\%$ of total patients group, while there was no case with worsened ECOG score. Fifteen patients died and the median interval from the start of treatment to death was 4 months (range: $1\~17$ months), while that of ten survivors was 9 months (range $5\~19$ months). There were five patients with controlled intrathoracic disease, who have survived over one rear. All deaths were associated with uncontrolled local and/or distant disease. Four Patients died of massive fatal hemoptysis, three of who received emergency endobronchial laser evaporation therapy before the start of endobronchial brachytherapy. Conclusion : Endobronchial brachytherapy has been confirmed as an excellent palliative treatment modality improving respiratory symptoms as well as patients' general performance status. Based on the current observations, use of endobronchial brachytherapy in curative setting as a boost technique may be warranted.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.15-20
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• 2003

Myasthenia gravis is a rare autoimmune disease involving acetylcholine receptor and its autoantibody on neuromuscular junction. The methods of treatment are medical treatment and surgical thymectomy. In this paper we analyzed the result of thymectomy and the factors affecting the postoperative symptom improvement. Material and method : This study obtained medical records of 37 patients who received the thymectomy for myasthenia gravis from March 1986 to December 1998. Result Out of 37 cases, 21 cases(57%) showed improvement, of which 8 cases (50%) in the group of thymoma(n=16), and 13 cases (62%) in the group of thymic hyperplasia(n=21) showed the improvement of symptoms. Postoperative complications were respiratory insufficiency due to aggravation of symptoms after operation, including tracheal intubation for ventilator support in 9 cases, pneumonia in 3 cases, pneumothorax in 2 cases and left vocal cord palsy in 1 case. There was one postoperative mortality. The relation between postoperative improvement and sex(P=0.3222), age(P=0.7642), thymic pathologic variants,(P=0.4335) and classification of thymoma(P=0.20) showed no statistically significant correlation. However, the lower grade of preoperative symptoms can predict the lower grade of postoperative symptoms significantly(P=0.0032). Follow up study to 36 postoperative survivors was performed in October 2002 based on the out-patient records and call with patients. Out of 36 cases, 33 cases(91.7%) could be investigated and 3 cases could not. Mean follow up period was 83.2 months. Out of 33 cases, 25 cases(75.8%) showed symptomatic improvement, of which 8 cases(53.3%) in the group of thymoma(n=15) and 17 cases(94.4%) in the group of thymic hyperplasia(n=18) showed the improvement of$\boxUl$ symptoms. Conclusion : In myasthenia gravis, thymectomy showed the good improvement, and more important factor affecting the improvement of symptoms was the grdae of preoperative symptoms. Also midterm and long term follow up results showed good symptomatic improvement.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.383-389
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• 1997

From March, 1992 to March, 1996, a total of 279 patients underwent coronary bypass surgery at the Sejong General Hospital, Puchon. We selected 22 patients with severe left ventricular(LV) dysfunction from them. The criteria were the presence of global or segmental abnormalities of left ventricular contraction and LV ejection fraction(EF) less than 35% based on biplane LV angiography by planimetry method. The mean age of 17 male and 5 female patients was 60$\pm$5.6years(range:47~73 years). All had the anginas, which were Canadian class II in 6, class 111 in 12 and class IV in 4. All patients except one had the history of previous myocardial infarction more than once. Seven of them had the symptoms and signs of congestive heart failure, such as dyspnea on excertion and increased pulmonary vascular markings. Their mean LVEF was 29.4$\pm$4 5%(range : 18~35%) and mean LV end-diastolic pressure was 18.7 $\pm$8. 2mmHg(range:10~42mmHg). 21 patients had 3 vessel-disease and 1 had 2 vessel-disease. Complete revascularization was tried with the use of 16 internal mammary arteries and 60 sapheuous veins and 3 radial arteries grafts. The mean number of distal anastomosis was 3.5$\pm$ 1.1. Concomitantly, one mitral valvuloplasty and annuloplasty was performed in the patient with moderate mitral regurtigation. The hospital mortality was 4.5%. During the follow-up, there were 3 late deaths. Of 18 survivors, 2 patients were lost in follow-up 24 and 27 month respectively after operation and the remaining 16 patients have bcen followed up with an average of 30.4 $\pm$ 13.4 months.15 patients had improvement with respect to angina but 8 patients still have the continuing or progressing heart failure. The 1-year, 2-year and 3-year actuarial survival rate was 85.2, 69.1, 46.1%, respectively. This study indicates that coronary artery bypass sur ery can be performed in the patients with severe LV dysfunction at acceptable risk but does not greatly contribute to the improvement of congestive heart failure.

• Journal of Animal Environmental Science
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• v.18 no.1
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• pp.19-24
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• 2012

The first objective of this study is to estimate emission coefficient of organic carbon regarding its inflow and discharge for dairy farm through reviewing domestic and foreign literature published or reported previously. Its second objective is to provide fundamental data to establish carbon cycle system related to livestock production. Based on literature review, emission coefficients by inflow of organic carbon into dairy farm were 5.9 ton C/head/year for feedstuff ingestion by milk cow, 2.3 ton C/head/year for recycling manure compost of milk cow to grassland, 318 g C/$m^2$/year for contents in grassland, 145 g C/$m^2$/year for contents in fodder crop, and 17 g C/$m^2$/year for $CO_2$ uptake by fodder crop, respectively. on the other hand, emission coefficients by discharge of organic carbon from dairy farm were 2,9 ton C/head/year for emission of $CO_2$ and $CH_4$ by respiration and burp of milk cow, 0.4 ton C/head/year for emission of $CO_2$ and $CH_4$ by decomposition of organic carbon in manure of milk cow, 440 g C/$m^2$/year for emission of $CO_2$ from grassland, and 0 for elution of organic carbon in grassland into underground water, respectively.

• Neonatal Medicine
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• v.17 no.1
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• pp.64-74
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• 2010

Purpose : The aim of this study was to determine the risk factors, clinical characteristics and prognosis for the development of periventricular leukomalacia (PVL) in preterm infants according to the extent and site of the PVL. Methods : The medical records of infants (under 36 weeks of gestational age) delivered from January 1999 to December 2008 were reviewed. Twenty-five preterm infants with were PVL were diagnosed by brain magnetic resonance imaging (MRI) and an addition 50preterm infants with no brain lesions were enrolled in this study. The perinatal and neonatal risk factors for the development of PVL was determine in these infants. Mental and Psychomotor Developmental Indices (MDI, PDI) were assessed by a clinical psychologist using the Bayley Scales of Infant Development II. We compared the differences of the clinical characteristics and prognosis according to brain MRI findings. Results : Maternal fever, young maternal age, extended oxygen use, hypotension within the first week of birth, use of inotropics within the first week of birth, and respiratory distress syndrome were the risk factors associated with PVL (P <0.05). In the multivariate analysis, maternal fever and extended oxygen use were statistically significant independent risk factors (P <0.05). The mean MDI and PDI scores of the PVL group (74.4$\pm$ 27.8 and 58.0$\pm$17.7) were significantly lower than those of the control group (103.5$\pm$8.9 and 101.7$\pm$16.1, P <0.05). Conclusion : Maternal fever and extended oxygen use were independent risk factors for PVL. We should pay attention to infants who had the risk factors and follow them up closely by brain imaging study and Bayley Scales of Infant Development II.

• Korean Journal of Agricultural and Forest Meteorology
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• v.12 no.4
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• pp.277-288
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• 2010

The multi-level $H_2O/CO_2$ profile system has been widely used to quantify the storage and advection effects on energy and mass fluxes measured by eddy covariance systems. In this study, we expanded the utility of the profile system by accommodating air sampling devices for isotope analyses of water vapor and $CO_2$. A pre-evacuated 2L glass flask was connected to the discharge of an Infrared Gas Analyzer (IRGA) of the profile system so that airs with known concentration of $H_2O$ and $CO_2$ can be sampled. To test the performance of this sampling system, we sampled airs from 8 levels (from 0.1 to 40 m) at the KoFlux tower of Gwangneung deciduous forest, Korea. Air samples in the 2L flask were separated into its component gases and pure $H_2O$ and $CO_2$ were extracted by using a vacuum extraction line. This novel technique successfully produced vertical profiles of ${\delta}D$ of $H_2O$ and ${\delta}^{13}C$ of $CO_2$ in a mature forest, and estimated ${\delta}D$ of evapotranspiration (${\delta}D_{ET}$) and ${\delta}^{13}C$ of $CO_2$ from ecosystem respiration (${\delta}^{13}C_{resp}$) by using Keeling plots. While technical improvement is still required in various aspects, our sampling system has two major advantages over other proposed techniques. First, it is cost effective since our system uses the existing structure of the profile system. Second, both $CO_2$ and $H_2O$ can be sampled simultaneously so that net ecosystem exchange of $H_2O$ and $CO_2$ can be partitioned at the same temporal resolution, which will improve our understanding of the coupling between water and carbon cycles in terrestrial ecosystems.