• Tuberculosis and Respiratory Diseases
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• v.51 no.2
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• pp.97-107
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• 2001

Background : Tuberculosis itself causes not only lung parenchymal destruction but also pulmonary vascular damage. Secondary emphysema also causes pulmonary vascular damage, which can develop as a late sequela of pulmonary tuberculosis. Therefore, pulmonary circulatory impairment tends to be more severe in post-tuberculosis emphysema than in primary emphysema. In post-tuberculosis emphysema, the right ventricular function may play an important role. However, little information regarding the right ventricular function is available. The purpose of this study was to evaluate and compare the right ventricular function between post-tuberculosis emphysema and primary emphysema. Method: Post-tuberculosis emphysema(PTE) or primary emphysema(PE) was diagnosed by history, HRCT finding and pulmonary function. Twenty patients with post-tuberculosis emphysema were matched with 20 patients with primary emphysema according to both $FEV-1$ and FVC. Arterial blood gas analysis and echocardiography were done at rest and immediately after symptom-limited exercise. The right ventricular function was evaluated with the right ventricular ejection fraction using a modification of Simpson's method. Results : There was no significant difference in the demographics and pulmonary function between the two groups. In post-tuberculosis emphysema, the $PaCO_2$ was higher ($42.9{\pm}4.7$ vs $38.8{\pm}3.1\;mmHg$ at rest; $47.9{\pm}7.0$ vs $41.1{\pm}5.9\;mmHg$ after exercise; p<0.01) and the right ventricular ejection fraction was lower ($57.6{\pm}6.5$ vs $61.4{\pm}4.7%$ at rest; $51.1{\pm}10.8$ vs $59.8{\pm}6.6%$ after exercise; p<0.01) both at rest and after exercise. The $PaCO_2$ after exercise was also lower ($65.7{\pm}12.6$ vs $80.2{\pm}14.4\;mmHg$, p<0.01), while the Pa02 at rest tended to be lower($82.9{\pm}12.0$ vs $87.8{\pm}7.5$, p>0.05). In both groups, right ventricular ejection fraction correlated with the $PaCO_2$ after exercise(PTE r=0.536, PE r=0.557), and the $PaCO_2$ at rest(PTE r=-0.576, PE r=-0.588) and after exercise(PTE r=-0.764, PE r=-0.619). Conclusion : Impairment of the right heart function and gas exchange were more serious in post-tuberculosis emphysema than in primary emphysema, and gas exchange may be influenced by the right ventricular function in post-tuberculosis emphysema.

• Clinical and Experimental Pediatrics
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• v.52 no.1
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• pp.81-86
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• 2009

Purpose : Febrile convulsions are classified into simple or complex types, the latter being characterized by increased risk of recurrence and progression to epilepsy. This study aimed to delineate the clinical characteristics of complex febrile convulsions. Methods : Between January 2003 and December 2006, 550 children were diagnosed with febrile convulsions at the Department of Pediatrics, Ilsan Paik Hospital. Their medical records were retrospectively reviewed for comparison between simple and complex febrile convulsions, and clinical findings of complex febrile convulsions were clarified. Results : Our subjects comprised a male-to-female ratio of 1.64:1; the age range was from 8 months to 8 years. Simple febrile convulsions comprised 432 cases, i.e., 4 times as many as complex febrile convulsions (118 cases). The causes of febrile illness included acute pharyngotonsillitis (357 cases, 64.9%), pneumonia (55 cases, 10.0%), acute gastroenteritis (37 cases, 6.7%), and otitis media (20 cases, 3.6%). We did not find any significant difference between simple and complex febrile convulsions in most clinical parameters such as gender, age, family history of febrile convulsions, and cause of febrile illness. Regarding subtypes of complex febrile convulsions, repeated convulsions were the most frequent (72.0%), followed by prolonged convulsions (16.9%) and focal convulsions (5.1%). Conclusion : We have reported here the clinical features of complex febrile convulsions. Although the results did not show any significant difference between simple and complex febrile convulsions in most clinical parameters such as gender, age, family history of febrile convulsion, and cause of febrile illness, further studies are essential to delineate complex febrile convulsions.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.1
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• pp.16-23
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• 2004

Purpose: In this study, we tried to evaluate the clinical characteristics or circumstances that lead to unintentionally the delay in the diagnosis of intussusception or to the wrong direction that prevent the proper management early. Methods: All the patients of intussusception with delayed diagnosis in the department of pediatrics or emergency room at Gyeongsang National University Hospital from 1990 to 2003 were enrolled and reviewed retrospectively. Results: There were 8 boys and 6 girls and their median age was 8 months (range 2 months to 10 years). Their initial symptoms and signs were vomiting, seizure, diarrhea, lethargy, irritability, bloody stool, palpable abdominal mass, foul odor of urine and tachycardia. Clinical diagnosis or impressions at admission consisted of acute gastroenteritis, shigellosis and toxic encephalopathy, convulsive disorders, urinary tract infections, sepsis, abdominal mass and intestinal obstruction. Eight patients were luckily diagnosed due to the delayed manifestations of cyclic irritability or currant jelly stool. Six patients were not paid attentions for the possibilities of intussusception and diagnosed serendipitiously by the abdominal sonography or CT during the evaluation of the abdominal mass or distension. Only five of 14 cases (35.7%) were successfully managed by barium or air reductions. The other 9 cases needed surgical operations. Conclusion: Delayed diagnosis of intussusception arise when doctors initially diagnose the patients incorrectly due to the unusual presentations or when they overlook the newly arising symptoms or signs suggestive intussusception after the admission because they are ardently attached to the first impressions or initial clinical diagnosis.

• Pediatric Infection and Vaccine
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• v.7 no.1
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• pp.94-107
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• 2000

Purpose : The purpose of this study is to know the clinical manifestations and the severity of adenoviral lower respiratory tract infections(LRTI) in Korean children. Methods : Adenoviral respiratory infection was diagnosed by viral culture in HEp-2 cell and indirect immunofluorescent technique with nasal aspirates. Isolated adenoviruses were typed by neutralization test. Retrospective chart review was done in patients with adenoviruses were typed by neutralization test. Retrospective chart review was done in patients with adenoviral lower respiratory tract infection, who were brought to Seoul National University Children's Hospital from November 1990 through February 1998. Results : Adenovirus was isolated in 87 cases. Of 84 cases serotyped, type 1 was recovered in 3 cases, type 2 in 13 cases, type 3 in 13, type 4 and 5 in 4 cases each other, type 6 in 1 cases, type 7 in 36 cases, type 11 in 1 case and the other types in 9 cases. Adenoviral lower respiratory infection occurred sporadically throughout the year but from November 1995 through February 1998, an outbreak of adenovirus type 7 lower respiratory infection was observed in number upto 36 case. The incidence of adenoviral infection peaked in young children between 6 months and 5 years of age and the mean age was 1 year 11 months old. There were 10 cases of mixed infection with another pathogen. Clinical diagnosis were pneumonia(88%), acute broncholitis(5.4%), acute tracheobronchitis(5.4%), croup(1.3%). The clinical features of adenoviral lower respiratory infection were severe especially in type 3 and 7 infections in aspect of fever duration, ventilator care. Extrapulmonary manifestations were gastrointestinal symptoms in 23 cases(31%), hepatomegaly in 36 cases(53%), seizure and mental alteration in 13 cases(20.3%). In chest radiographic findings, parahilar and peribronchial infiltration were in 49 cases(67%), hyperaeration in 21 cases(29%), atelectasis in 14 cases(19%), consolidation in 39 cases(53%) and bilateral pneumonic infiltration in 28 cases(38%). Among thirty six adenovirus type 7 LRTI, 15 patients(41.6%) had pleural effusion and 3 patients had chest tube insertion. Number of fetal cases related to adenovirus were 9 cases(12%) and fetal cases due to ventilatory failure were 7(11%). Conclusion : During 7 year period of studying adenoviral lower respiratory infection, we identified the serotypes of adenovirus. Among the serotypes, adenovirus type 7 were epidemically isolated. Adenovirus were isolated in severe lower respiratory infection of young children aged between 6 months and 5 years and related to death of the patients, especially when the patients had underlyng diseases or were infected by adenovirus type 7.

• Neonatal Medicine
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• v.17 no.2
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• pp.224-231
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• 2010

Purpose: Hospital readmissions have recently increased due to early hospital discharge and increased trends in breast-feeding. Neonatal hyperbilirubinemia can lead to fatal permanent neurological sequelae without appropriate management. Early detection and intervention are critical. We evaluated the clinical features, risk factors, and brain MRI findings of Korean newborns with idiopathic nonhemolytic hyperbilirubinemia to determine the optimal management policy. Methods: A retrospective review of the medical records of 79 newborns with idiopathic nonhemolytic hyperbilirubinemia was performed at the NICU of the Kyungpook National University Hospital from January 2006 to September 2009. All patients were 35 or more weeks of gestation, and their peak level of serum total bilirubin was more than 20 mg/dL. Results: The mean gestational age was $38^{+3}{\pm}1^{+4}$ weeks, and the mean age on admission was 8.8$\pm$4.0 days. The mean body weight (3,105$\pm$479 g) was decreased by 2.8$\pm$6.4 percent compared to the mean birth weight (3,174$\pm$406 g). There were no statistically significant differences for the peak serum bilirubin level or the duration and effects of phototherapy between the patients with and without risk factors, which included: breastfeeding, cephalohematoma, subdural hemorrhage, and/or ABO incompatibility. Patients were grouped according to change of body weight. Group I consisted of patients that gained weight compared to birth weight, and group II of patients that lost weight compared to birth weight. There were significant differences in the peak serum total bilirubin level between the two groups. Thirty nine patients had brain MRI evaluation; 21 patients had bilateral symmetric signal intensity increases in the globus pallidus compared to adjacent corticospinal tract and putamen on T1-weighted images. Conclusion: Bilirubin encephalopathy is preventable with early screening and proper management. Parents require instruction on feeding practices and follow-up to prevent complications from idiopathic nonhemolytic hyperbilirubinemia.

• Journal of agricultural medicine and community health
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• v.30 no.3
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• pp.279-292
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• 2005

Objectives: The purpose of this study is to analyze agricultural accident and disease using statistical data and materials about National Survey for Health & Nutrition in 2001 and to provide fundamental materials for studies about farmers' health and safety, decision of priority about research and policy. Results: Diagnosed chronic disease prevalence is 72.4% in farmer/fisher group, 49.8% in non farmer/fisher group. The chronic disease prevalence of musculoskeletal disease, circulatory disease, and gastroenteric disease is 46.5%, 18.2%, and 17.9% in farmer/fisher group respectively. The prevalence of musculoskeletal disease in farmer/fisher is 2.4 times higher than non farmer/fisher. This result shows that it need to evaluation for risk factors of musculoskeletal disease preferentially. Lifetime accident/poisoning rate is 18.2% In farmer/fisher group and 13.3% in non farmer/fisher group. The types of accidents were fracture>sprain>contusion and the reasons of accidents were traffic accident>falling/sliding. Conclusions: "Bad or very bad" response of farmer/fisher is almost 2 times higher than non farmer/fisher group. The rate of smoking and no exercising in farmer/fisher group is higher than non farmer/fisher group.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.1
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• pp.34-41
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• 2016

Adult-onset type II citrullinemia (CTLN2) is characterized by episodes of neurologic symptoms associated with hyperammonemia leading to disorientation, irritability, seizures, and coma. CTLN2 is distinct from classical citrullinemia, which is caused by a mutation of the argininosuccinic acid synthetase (ASS) gene. The serum citrulline level is elevated, while the activity of ASS in liver tissue is decreased. CTLN2 is known to have a poor prognosis if the proper treatment is not taken. We reported a female aged 37 years who developed recurrent attacks of altered consciousness, aberrant behavior, and vomiting. We initially suspected the patient had CTLN2 because of the signs of hyperammonemic encephalopathy, such as altered mentality, memory disturbance, and aberrant behaviors provoked by exercise-induced stress and excessive intravenous amino acid administration. Through her peculiar diet preferences and laboratory findings that included hyperammonemia and citrullinemia, we diagnosed the patient as CTLN2, and SLC25A13 sequencing revealed known compound heterozygous mutations (IVS11+1G>A, c.674C> A). Her parents were heterozygous carriers, and we identified that her older sister had the same mutations. The older sister had not experienced any episodes of hyperammonemia, but she had peculiar diet preferences. The patient and her sister have been well with conservative management. When considering the clinical course of CTLN2, it was meaningful that the older sister could be diagnosed early in an asymptomatic period and that preemptive treatment was employed. Through this case, CTLN2 should be considered in adults who present symptoms of hyperammonemic encephalopathy without a definite etiology. Because of its rare incidence and similar clinical features, CTLN2 is frequently misdiagnosed as hepatic encephalopathy, and it shows a poor prognosis due to the lack of early diagnosis and proper treatment. A high-carbohydrate diet, which is usually used to treat other urea cycle defects, can also exaggerate the clinical course of CTLN2, so proper metabolic screening tests and genetic studies should be performed.

• Clinical and Experimental Pediatrics
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• v.45 no.11
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• pp.1411-1416
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• 2002

Purpose : Although the use of intravenous gamma-globulin(IVGG) in Kawasaki disease(KD) is effective in reducing clinical symptoms and coronary artery complications, 20-30% of patients have persistent or recrudescent fever and ongoing clinical symptoms. In these patients, the additional infusion of IVGG is considered. The authors studied the characteristics of patients who received IVGG retreatment, and compared them with the patients who did not need IVGG retreatment, for determination of IVGG retreatment. Methods : We reviewed the medical records of 117 KD patients who could be followed up at least six months. We studied the conventional laboratory findings, electrocardiogram(EKG), signal averaged ECG(SAECG) and echocardiogram. Results : Twenty three patients had early cardiac complications during the six months of follow-up. Four patients had late cardiac complications after six months. The early cardiac complication rate was higher in the IVGG retreatment group than the single infusion group(P<0.0001). The late complication rate was also higher in the retreatment group(P<0.0001). The patients who received methyl-prednisolone(m-PD) pulse therapy had much higher rates of early and late cardiac complications than those who received a single IVGG infusion. Among the clinical data and laboratory findings, only CRP increased significantly in patients who have had the cardiac complications. The IVGG retreatment group had increased CRP than the single infusion group. Conclusion : The patients with increased initial CRP may have an increased incidence of complications and an increased possibility of IVGG retreatment. We thought that retreated KD patients might have inflammations severe enough to need high dose IVGG as shown by high CRP levels, and IVGG retreatment could not prevent coronary artery lesions sufficiently.

• Clinical and Experimental Pediatrics
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• v.50 no.10
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• pp.959-964
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• 2007

Purpose : The purpose was to investigate the clinical considerations of patients affected by meconium aspiration syndrome (MAS) and the effect of suctioning through endotracheal intubation immediately after delivery on the prognosis of MAS. Methods : A total of 44 inpatients diagnosed as MAS in the Neonatal Intensive Care Unit (NICU) at Cheil Hospital were selected from January 2004 to June 2006. They were divided into two groups. In the early aspiration group (12 patients), suctioning through endotracheal intubation was performed according to the neonatal resuscitation program of the American Academy of Pediatrics and the American Heart Association because infants born through meconium-stained amniotic fluid (MSAF) were not vigorous after birth. In the early non-aspiration group (32 patients), endotracheal intubation was not performed because the infants born through MSAF were vigorous after birth. These two groups were analyzed retrospectively by medical records in the fields of clinical features, obstetric risk factors, complications, treatment, and duration of hospitalization. Results : There was no significant difference in mean gestational age, mean birth weight, sex, and delivery mode between the early aspiration group and the early non-aspiration group. Mean Apgar score of the early aspiration group both in 1 and 5 minute score was significantly lower than in the early non-aspiration group. Lengths of hospitalization and duration of mechanical ventilator care were longer in the early non-aspiration group, but there was no significant difference. Total duration of oxygen therapy was significantly longer in the early non-aspiration group than in the early aspiration group. Conclusion : In this study, the early non-aspiration group used surfactant more and had a longer duration of mechanical ventilator and hospitalization, but there was no significant difference. Total duration of oxygen therapy was significantly longer in the early non-aspiration group. Therefore, more detailed guidelines for vigorous infants born through MSAF are needed and we should study and follow up the long term prognosis of neurological complications of MAS.

• Childhood Kidney Diseases
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• v.18 no.1
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• pp.29-35
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• 2014

Introduction: Persistent vesicoureteral reflux (VUR), a major cause of urinary tract infection (UTI) in children, can result in serious renal complications, such as reflux nephropathy and chronic renal failure. We evaluated the clinical characteristics and prognostic factors of VUR. Methods: From December 1993 to May 2011, we examined 117 children with vesicoureteral reflux who were admitted to the Department of Pediatrics and Urology, Chungbuk National University hospital for a UTI. The patients were managed medically or surgically. Results: Male patients had a slightly higher prevalence of VUR than female patients (55%). The degrees of the 161 refluxing ureters, as classified by the International Reflux Study Committee, were as follows: grade I, 15 ureters; grade II, 32 ureters; grade III, 54 ureters; grade IV, 26 ureters; grade V, 34 ureters. One hundred and sixty-one renal units (115 cases) underwent a 99m TC-DMSA renal scan, and 62% showed abnormal findings. The incidence of renal cortical defects showed a direct correlation with the severity of VUR. Ninety-four refluxing ureters were followed up medically, and 66 ureters (67%) either disappeared or improved. However, 9 refluxing ureters persisted. The spontaneous resolution rate of VUR seemed to be higher in younger patients with lower grades of reflux, and without renal cortical defects. Sixty-seven refluxing ureters (41%) were treated surgically, 62 refluxing ureters (92%) disappeared, and 5 refluxing ureters (8%) persisted. Conclusion: The incidence of renal cortical defects in patients with UTIs was 62% (in a 99m TC-DMSA renal scan), and showed a direct correlation with the severity of VUR. The spontaneous resolution rate seemed to be lower in the patients with higher grades of VUR, older age (over 4 years old) and diffuse renal cortical defects.