• IMMUNE NETWORK
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• 제24권2호
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• pp.18.1-18.12
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• 2024

Acute necrotizing encephalopathy (ANE) is a rare but deadly complication with an unclear pathogenesis. We aimed to elucidate the immune characteristics of H1N1 influenza virus-associated ANE (IANE) and provide a potential therapeutic approach for IANE. Seven pediatric cases from a concentrated outbreak of H1N1 influenza were included in this study. The patients' CD4⁺ T cells from peripheral blood decreased sharply in number but highly expressed Eomesodermin (Eomes), CD69 and PD-1, companied with extremely high levels of IL-6, IL-8 in the cerebrospinal fluid and plasma. Patient 2, who showed high fever and seizures and was admitted to the hospital very early in the disease course, received intravenous tocilizumab and subsequently showed a reduction in temperature and a stable conscious state 24 h later. In conclusion, a proinflammatory cytokine storm associated with activated CD4⁺ T cells may cause severe brain pathology in IANE. Tocilizumab may be helpful in treating IANE.

• 대한영상의학회지
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• 제82권5호
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• pp.1274-1280
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• 2021

급성 괴사성 뇌병증은 드물지만 특징적인 인플루엔자 관련 뇌병증으로, 시상을 포함한 영역의 좌우 대칭의 다발성 병변을 특징으로 한다. 급성 괴사성 뇌병증의 정확한 발병 기전은 아직까지 불분명하나, 사이토카인 과분비에 의한 혈액뇌장벽의 파괴가 가장 널리 받아들여지는 가설이다. 저자들은 급격하게 진행한 10세 남아의 급성 괴사성 뇌병증 증례를 확산강조영상과 자화강조영상을 포함한 연속 자기공명영상 소견과 함께 보고하고자 한다. 연속 자기공명영상에서 나타나는 뇌병변의 시간적 변화는 임상경과 및 병태생리학적 변화와 일치되는 소견을 보였다. 본 증례는 연속 자기공명영상 소견을 통해 급성 괴사성 뇌병증 뇌병변의 발생 기전을 명확히 하였으며, 더 나아가 빠른 면역조절치료를 통해 뇌 손상의 정도를 줄일 수 있음을 시사하였다.

• Clinical and Experimental Pediatrics
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• 제57권8호
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• pp.351-356
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• 2014

Purpose: Among the many factors associated with acute intestinal mucosal infection, numerous studies have proposed the usefulness of fecal calprotectin. The aim of this study was to evaluate the usefulness of fecal calprotectin in the diagnosis of necrotizing enterocolitis (NEC). Methods: We collected 154 stool samples from 16 very low birth weight and premature newborns at the Konyang University Hospital neonatal intensive care unit or neonatal nursery. The stool samples were collected using the Calprest device, and the fecal calprotectin level was measured with the $B\ddot{U}HLMANN$ Calprotectin enzyme-linked immunosorbent assay kit. Results: Fecal calprotectin levels were significantly higher in the NEC group than in the non-NEC group (P=0.02). There was a significant positive linear relationship between the fecal calprotectin level and number of days after birth (P=0.00) in the gestational age <26 weeks group. There was a significant negative linear relationship between the calprotectin level and number of days after birth (P=0.03) in the gestational age ${\geq}26$ weeks and <30 weeks group. There was no difference in the calprotectin levels according to the type and method of feeding between the NEC and non-NEC groups. Conclusion: Fecal calprotectin levels were significantly increased in premature infants with NEC. The fecal calprotectin test is a noninvasive, easy, and useful tool for the diagnosis of NEC.

• 한국임상수의학회지
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• 제22권3호
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• pp.284-287
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• 2005

A 18-month-old, male Maltese dog with acute seizure was referred to Veterinary Medical Teaching Hospital, Kyungpook National University. Abnormal neurologic findings included a tendency to fall to the left, turn and circle to the right, negative bilateral menace responses and pupillary light reflexes, and diminished responses to facial sensation testing on both sides. Radiographic signs were normal, except for occipital dysplasia. Magnetic resonance imaging of the brain revealed bilateral asymmetric ventriculomegaly, which is more on left side. Cerebral edema was also suspected. The dog died after 9 days from the onset of seizure, and a necropsy was performed. Histopathologically, the brain lesions in the meninges and the cerebral cortex of this dog was presented. There was severe diffuse nonsuppurative inflammation in perivascular area of the meninges and the cerebral white matter. Based on the results, this case was diagnosed as necrotizing meningoencephalitis in Maltese dog.

• Pediatric Infection and Vaccine
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• 제15권2호
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• pp.206-211
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• 2008

소아 연령에서 침습성 질환의 가장 흔한 원인균인 폐구균은 드물게 용혈성 요독 증후군을 일으키는 원인이 되기도 하며, 심한 폐렴을 일으키는 경우 농흉이나 괴사성 폐렴을 합병하기도 한다. 저자들은 33개월 여자가 폐렴 및 흉막 삼출로 내원하여 용혈성 요독 증후군으로 진행하였고, 급성 호흡곤란증후군 및 괴사성 폐렴이 합병되었으며, 혈액 및 흉수배양검사상 혈청형 19A의 폐구균 감염이 확인된 1례를 경험하였다. 환아는 항생제, 복막투석과 인공호흡기 적용등의 치료를 받았으며, 약 2개월 간의 입원치료 후 신기능이 정상화되어 퇴원하였고, 5년간의 외래 추적관찰 결과 신장 계통의 합병증 및 폐기능의 이상 소견 없이 완전히 회복되었기에 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제66권3호
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• pp.225-229
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• 2009

저자들은 복통을 주소로 내원하여 급성 무결석 담낭염으로 진단받고 치료 중 미만성 폐포 출혈이 발생한 Churg-Strauss 증후군 환자 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• 대한영상의학회지
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• 제81권6호
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• pp.1436-1447
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• 2020

목적 간질부종성 췌장염으로 진단된 환자군에서 괴사성 췌장염으로의 진행을 예측할 수 있는 입원 당시 초기 임상소견 및 CT 소견을 알아보고자 한다. 대상과 방법 간질부종성 췌장염으로 진단되어 입원 당시 및 14일 이내 추적 조영증강 CT를 시행한 178명의 환자를 대상으로 하였다. 두 명의 영상의학 전문의가 추적 CT를 분석하여 간질부종성 또는 괴사성 췌장염을 결정하였다. 입원 당시 혈액검사 소견도 기록하였다. 간질부종성-간질부종성 췌장염 환자군과 간질부종성-괴사성 췌장염 환자군 간에 임상소견, CT 소견 및 혈액검사 소견들을 비교하였다. 다변량 분석도 시행하였다. 결과 간질부종성-간질부종성 췌장염 환자군은 112명, 간질부종성-괴사성 췌장염 환자군은 66명이었다. 알코올성 췌장염의 비율은 간질부종성-괴사성 췌장염 환자군이 더 높았다. 입원 당시 CT 소견 중 췌장주위 액체저류, 췌장실질의 비균질성은 간질부종성-괴사성 췌장염 환자군에서 더 흔하게 나타났다. 입원 당시 혈액검사 소견 중 혈청 C-반응성 단백 수치 및 백혈구수가 간질부종성-괴사성 췌장염 환자군에서 더 높게 나타났다. 다변량 분석을 시행했을 때 췌장주위 액체저류와 췌장실질의 비균질성 소견이 두 환자군을 구별하는데 유의한 인자로 나타났다. 결론 초기 CT상 간질부종성 췌장염으로 진단된 환자군에서 CT 소견 중 췌장주위 액체저류, 췌장실질의 비균질성은 괴사성 췌장염으로의 진행을 예측하는 데 도움이 된다.

• Journal of Chest Surgery
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• 제47권1호
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• pp.43-46
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• 2014

Phlegmasia cerulea dolens (PCD) is one of the most critical disorders of acute deep vein thrombosis in that it can cause permanent disability secondary to the compartment syndrome. Although several etiological factors have been proposed, PCD after coronary artery bypass surgery is extremely rare and its definitive pathophysiology is still under debate. We herein present a case of PCD that resulted in the compartment syndrome after coronary artery bypass surgery. Early recognition and decompression of PCD are crucial for saving the affected limbs.

• Tuberculosis and Respiratory Diseases
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• 제45권4호
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• pp.888-895
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• 1998

Malaria is one of the most common infectious diseases in the world. Plasmodium falciparum, accounting for nearly all malaria mortality, kills an estimated 1 to 2 million persons yearly and has several features that make it deadlist of malarias. While cerebral malaria is the most common presentation of severe disease, acute lung injury associated with malaria is uncommon but serious and fatal complication. We report two cases of severe malaria with ARDS and multi-organ failure. All two patients traveled to foreign countries, Kenya, Papua New Guinea where choroquine-resistant malaria is distributed. The first case, which developed cerebral malaria, hypoglycemia, multi-organ failure, and ARDS, treated with quinine and mechanical ventilator, but expired due to oxygenation failure. Autopsy showed acute necrotizing infiltration, diffuse eosinophilic fibrinoid deposits along the alveolar space, and alveolar macrophage with malaria pigment The second case also developed multi-organ failure, followed by ARDS, and was treated with quinine, exchange transfusion, plasmapheresis, and mechanical ventilator. He recovered with residual restrictive lung change after treatment.

• Advances in pediatric surgery
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• 제9권1호
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• pp.19-23
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• 2003

Necrotizing Enterocolitis (NEC) is usually a disease of premature infants, but occasionally it affects the term neonate. Twenty-five infants with NEC were treated at Asan Medical Center between January 2000 and December 2002, and 13 of them were term infants. In each case, the diagnosis of NEC was established by a clinical illness fulfilling the Bell's stage II or III NEC as modified by Walsh or by surgical findings. There were six males and seven females. The birth weight was from 1,960 to 3,700 g. The age at diagnosis was from 1 to 40 days. Four patients had congenital heart disease: one of who had hypothyroidism and cleft palate. Abdominal distension was present in all, and bloody stools in four. One patient had history of hypoglycemia, three had Rota viral infection. Eight patients had leucopoenia (<$5.0{\times}10^9/L$), seven had thrombocytopenia (<$100{\times}10^9/L$), and three severe thrombocytopenia (<$50{\times}10^9/L$). Laparotomy was required in 10 of the 13 patients. Indications for operation in the acute phase were failure to respond to aggressive medical therapy in five, and perforation in three patients. There were two late phase operations for intestinal stricture and fistula. There were no operative complications. Ten of thirteen patients survived (76.9%). Two patients died of septic complication. There was a delayed death due to heart failure. There was a significant difference in survival according to platelet count ($50{\times}10^9/L$) (p<0.05). Congenital heart disease and Rota viral infection are associated with NEC in term infants and thrombocytopenia and leucopoenia may be surgical indications.