• Clinical and Experimental Pediatrics
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• v.45 no.12
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• pp.1577-1584
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• 2002

Purpose : Airway inflammation is considered to be a characteristic feature of asthma, and eosinophils are recognized as the most important inflammatory cells. This study aims to assess the importance of blood eosinophil count and serum eosinophil cationic protein(ECP) levels as a noninvasive marker of bronchial hyperresponsiveness(BHR) in children with suspected asthma. Methods : This study used data from 87 subjects with asthma-like symptoms(6-18 years old). The $FEV_1$ and provocative concentration producing a 20% fall in $FEV_1(PC_{20})$ on methacholin inhalation challenge test were measured. Four groups were classified based on $PC_{20}$[Group I : <2 mg/mL; Group II : 2-8 mg/mL; Group III : 8-18 mg/mL; Group IV : (18 mg/mL], and blood eosinophil count and serum ECP levels were analyzed. In addition, subjects were classified based on the cutoff value of $PC_{20}$(BHR positive group : <18 mg/mL; BHR negative group : (18 mg/mL). Then blood eosinophil count and serum ECP level were compared between these two groups. Results : Likelihood ratio test for trends revealed a significant association between the blood eosinophil count or serum ECP level, and the degree of BHR as measured by methacholine $PC_{20}$. Blood eosinophil count or serum ECP level was significantly higher in the BHR(+) group than in the BHR(-) group. Blood eosinophil count had a positive correlation with serum ECP level. Conclusion : Blood eosinophil count and serum ECP level may be a useful non-invasive clinical marker of BHR in subjects with suspected asthma. This supports the hypothesis that BHR in asthma is a consequence of airway eosinophilic inflammation.

• Journal of Society of Preventive Korean Medicine
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• v.1 no.1
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• pp.85-104
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• 1997

As the concern about health is increased, the importance of preventive medicine that prevent disease in advance to overcome boundary of disease remedy gets emphasized in the whole world. The fundamental thoughts of oriental medicine are the harmony between the human body and nature, the unified idea regarding mind in the same light with body, and the symmetry of the cosmo dual forces. And oriental medicine is a kind of study that has developed on the ground of prevention thought. from old days, it has been developed the preventive medicine at is called 'Yangseng(養生; recuperation)' etc. with the clinical medicine. The preventive medicine of oriental medicine was taking a serious of the first preventive medicine of an incurable disease thought and the prevention thought that belongs to the second and third preventive medicine is described through the whole oriental medicine. Also the clinical and preventive medicine to apply to the clinics have an in- separable relation. Therefore I inspected the part of the preventive medicine described in some oriental medicine books and studied the characteristics of preventive medicine of oriental medicine as follows; First, the preventive medicine of oriental medicine has the characteristics that is emphasized generally in the first preventive medicine and wholly it is composed in the system of the first, second and third preventive medicine. It has the presentative theory such as 'Jungkijonae sabulkaghan(正氣存內 邪不可干; If good energy is in body, a disease. dosen't occur)', 'Husajukpung Phijeyushi(虛邪賊風 避之有時; When e infectious disease like plague break out, they must avoid the place occurring the disease)', 'Chuninsangeung(天人相應; The harmony of nature and human)' etc.. This is intimately related to the incurable disease thought of the inside diameter and oriental medicine has pursued that. Second, due to the most prerequisite theory of disease production, the balanced condition of environment, the cause of a disease and host is called the health. As oriental medicine has the system of aetiology like that, we can see the host and environments are importance most of all. Namely we can think of the relation of host >> environment > the cause a disease Up to date Jungkijonae Sabulkaghan(正氣存內 邪不可干) that the most oriental medicine doctors have had a knowledge is not whole theory but a pan of oriental medicine science and it is included in oriental medicine theory to avoid infectious disease such as Husajukpung Phijeyushi(虛邪賊風 避之有時). Third, according to the natural result of the first and second contents, we can know that its characteristics stress the remedy without drugs. Because Jungkijonae Sabulkaghan(正氣存內 邪不可干), Husasukpung Phijeyushi(虛邪賊風 避之有時), and Chuninsangeung(天人相應) mean that they prevent disease in condition of freedom from ailment, We can prevent the disease production through the positive preventive methods such as exercise, spirit, food and innate prevention etc.. fourth, the preventive medicine of oriental medicine has developed with therapeutics and it contains all oriental medical methods such as host, environment, exercise, acupuncture and moxibustion, innate or postnatal methods. Also it is the general preventive medicine that has fundamental philosophy of oriental medicine; for examples, the unified idea, the harmony of nature and human, and the unity of mind and body. fifth, to develope the above scientific merit and special features, the preventive medicine of Oriental medicine must be objectified and reemergent stud? gets more and more essential from now on. Especially we need to have the scientific concern of Oriental medicine about the cause of a disease, environmental hygiene, industrial sanitation, and personal hygiene etc..

• Journal of The Korean Society of Inherited Metabolic disease
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• v.21 no.1
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• pp.7-14
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• 2021

Purpose: Pseudohypoparathyroidism (PHP) is caused by genetic and epigenetic alteration in the GNAS locus, and characterized by the resistance to multiple hormones and the Albright's hereditary osteodystrophy (AHO) phenotype. This study investigated the phenotypic characteristics and molecular features of PHP. Methods: Eight patients who diagnosed as PHP were enrolled at Pusan National University Children's hospital and clinical features, biochemical and genetic findings were retrospectively reviewed. Results: Of a total of 8 patients, 5 were diagnosed with PHP1a, and 3 were diagnosed with PHP1b. Patients with PHP1a had three different mutations in the GNAS gene, and patients with PHPIb had imprinting defect in differentially methylated regions (DMRs) of the GNAS locus. Two novel GNAS variants were identified in patients with PHP1a, including c.313-2A>T and c.1094G>A. All patients with PHP1a displayed AHO features; short stature (80%), brachydactyly (80%), a round face (80%), obesity (40%), heterotopic ossification (60%), and intellectual disability (60%), whereas only one patient (33.3%) with PHP1b showed AHO feature such as a round face. When phenotypic features between PHP1a and PHP1b patients were compared, patients with PHP1b showed a tendency of higher current height standard deviation scores (SDS) compared to patients with PHP1a, (-3.2±2.1 vs.-1.1±0.8; P=0.06) Conclusions: This study summarizes the phenotypic and genetic features of the PHP patients. Although we found considerable clinical overlap between PHP1a and PHP1b, further long-term follow-up is needed to evaluate the growth and development of children with PHP, as well as the effects of end-organ resistances to endocrine hormones.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.369-377
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• 1997

Purpose : This study was Performed to identify the histopathologic feature by the reevaluation of the Pathologic specimen of the cervical tumors and to evaluate the clinical findings and the treatment results of the patients with small cell carcinoma of the cervix treated by radiotherapy. Materials and Methods : 2890 patients with cervical carcinoma received radiotherapy at the Department of Radiation Oncology. Yonsei Cancer Center, Yonsei University College of Medicine between October 1981 and April 1995. Of the 2890 patients in this data base, sixty were found to have small cell carcinomas $(2.08\%)$. Among them thirty six patients were transferred from other hospitals. the biopsy specimens of those Patients were not available. So we could review the slides of the other twenty four patients who were diagnosed at our hospital. Twenty four patients with small cell carcinoma of the cervix were analyzed retrospectively based on the assessment of H & E staining and other four immunohistochemical stains for neuroendocrine differentiation (neuron specific enolase, chromogranin. synaptophysin and Grimelius stain). And we also evaluate the Patients and tumor characteristics. response to radiation. patterns of failures, 5 year overall and disease free survival rates. Results : Thirteen tumors were neuroendocrine carcinomas(13/24 = $54.2\%$) and eleven tumors were squamous carcinomas, small cell type (11/24 = $47.8\%$) based on the assessment of H & E staining and other four neuroendocrine marker studies. So we classified the Patients two groups as neuroendocrine carcinoma and small cell type of squamous carcinoma, Among the 13 neuroendocrine carcinomas, five were well to moderately differentiated tumors and the other eight were Poorly differentiated or undifferentiated ones. The median age was 54 years old (range 23-79 years). Eight Patients had FIGO stage IB disease, 12 had stage 11, 3 had stage III and one had stage IV disease, Pelvic lymph node metastases were found in five Patients $(20.8\%)$. three of them were diagnosed by surgical histologic examination and the other two were diagnosed by CT scan. There was no difference between two histopathologic groups in terms of patients and tumor characteristics. response to radiation. 5 year overall and disease free survival rates. However the distant metastases rate was higher in neuroendocrine carcinoma Patients (6/13:$46.2\%$) than in small cell type of squamous carcinoma Patients (2/11:$18.2\%$), but there was no statistically significant difference because of the small number of patients (P>0.05). Conclusion : More than half of the small cell carcinoma of the cervix patients were neuroendocrine carcinoma (13/24 : $54.1\%$) by reevaluation of the biopsy specimen of the cervical tumors. The tendency of distant metastases of the neurolndocrine carcinoma was greater than those of the small cell type of squamous carcinoma $(46.2\%\;vs.\;18.2\%)$. But there were no differences in the patients and tumor characteristics and other clinical treatment results in both groups. These data suggest that radical local treatment such as radiotherapy or radical surgery combined with combination systemic cytotoxic chemotherapy might provide these patients with the best chance for cure.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.232-240
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• 1997

Background : Postprimary pulmonary tuberculosis is located mainly in upper lobes. The tuberculous lesion involving the lower lobes usually arises from the upper lobe cavity through endobronchial spread. When tuberculosis is confined to the lower lung field, it often masquerades as pneumonia, lung cancer, bronchiectasis, or lung abscess. Thus the correct diagnosis may be sometimes delayed for a long time. Methods : We carried out, retrospectively, a clinical study on 50 patients confirmed with lower lung field tuberculosis who visited the Department of Pulmonary Medicine at Hanyang University Hospital from January 1992 to December 1994. The following results were obtained. Results : Lower lung field tuberculosis without concomitant upper lobe disease occurred in fifty patients representing 6.9% of the total admission with active pulmonary tuberculosis over a period of 3 years. It occurred most frequently in the third decade but age distribution was relatively even. The mean age was 43 years old. Female was more frequently affected than male (male to female ratio 1 : 1.9). The most common symptom was cough(68%), followed by sputum(52%), fever(38%), and chest discomfort(30%). On chest X-ray of the 50patients, consolidation was the most common finding in 52%, followed by solitary nodule(22%) collapse(16%), cavitary lesion(10%), in decreasing order. The disease confined to the right side in 25 cases, left side 20 cases, and both sides 5 cases. Endobronchial tuberculosis (1) Endobronchial involvement was proved by bronchoscopic examination in 20 of 50patients. (2) Mean age was 44years old and female was more affected than man (male to female ratio 1 : 3). Sputum AFB stain and Mycobacterium tuberculosis culture were positive only in 50% of cases unlikely upper lobe tuberculosis, additional diagnostic methods were needed. In our study, bronchoscopic examination and percutaneous fine needle aspiration biopsy increased diagnostic yield by 18% and 32%, respectively. The most common associated condition was diabetes mellitus(18%) and others were anemia, anorexia nervosa, stomach cancer, and systemic steroid usage. Conclusion : When we find a lower lung field lesion, we should suspect tuberculosis if the patient has diabetes mellitus, anemia, systemic steroid usage, malignancy or other immune suppressed states. Because diagnostic yield of sputum AFB smear & Mycobacterium tuberculosis culture was low, additional diagnostic methods such as bronchoscopy and fine needle aspiration biopsy were needed.

• Journal of the Korean Arthroscopy Society
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• v.10 no.1
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• pp.70-76
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• 2006

Purpose: This study presents 5 patients who had metallic anchor protrusion on glenoid after Bankart repair in anterior shoulder instability and reviewed the cause, clinical feature and arthroscopic removal technique. Method and Materials: 5 male with average age of 22 years (range 19 to 25 years) were included. 4 patients had arthroscopic Bankart repair and 1 patient had open repair for anterior shoulder instability. They had protruded metallic suture anchors on glenoid and the protruded suture anchors were removed arthroscopically using larger suture anchor empty inserter. Results: 4 patients had painful clicking sound with motion of abduction and external rotation and 1 patient showed shoulder instability. The ROM showed normal except mild degrees loss of external rotation. The position of protruded metallic anchor was 2, 3 and 5 O'clock in three patients and 4 O'clock in 2 patients. In 2 patients, the metallic suture anchor was malpositioned about 5mm off on the medial side from the anterior glenoid edge. All had Outerbrige classification Grade II-III chondral damage on humeral head and 1 patient showed glenoid cartilage destruction. None had shoulder instability after 2 years of follow-up. Constant score was 65 preoperatively and 89 postoperatively. ASES score was 67 preoperatively and 88 postoperatively. Conclusion: Symptoms of protruded suture anchor are not combined with instability. Most of symptoms were revealed from the rehabilitation period and confused with postoperative pain. Prompt diagnosis and early arthroscopic removal or impaction of protruded metallic suture anchor is recommended because of serious glenohumeral cartilage destruction. This is easy and simple and reproducible method to remove protruded metallic suture anchor arthroscopically.

• Clinical and Experimental Pediatrics
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• v.52 no.6
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• pp.674-679
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• 2009

Purpose : The authors aimed to analyze the long-term effects of treatments, especially external beam radiotherapy (EBRT), in bilateral retinoblastoma patients. Methods : This retrospective study analyzed the medical records of 22 bilateral retinoblastoma patients who were registered between October, 1987 and October, 1998 and followed-up for more than 10 years. They were treated by enucleation, EBRT, and systemic chemotherapy. Age at diagnosis, sex, delay prior to treatment, Reese-Ellsworth (RE) classification, and the local treatment modalities were analyzed in relation to recurrence-free survival (RFS) and complications. Results : Median age at diagnosis was 7.0 months (range 1.7-31.6 months). Leukocoria was the most common presenting feature. Two patients had a familial history. The RE classifications of the 44 eyes were group II in 4, III in 14, IV in 4, and V in 22. At the end of a median follow-up period of 141 months (range 55-218 months), 20 patients were alive. The 10-year ocular survival rate of the 44 eyes was $56.8{\pm}7.5%$. The 10-year RFS and ocular survival rate of the 29 eyes treated by combined EBRT and chemotherapy were 75.9% and 86.2%, respectively. Treatment delay (>3 months) was found to be related to higher risk of recurrence. Complications after EBRT were cataract, retinal detachment, phthisis bulbi, and facial asymmetry. No patient developed a second malignancy during the follow-up period. Conclusion : Early detection and prompt treatment can increase ocular survival rates. In addition, careful attention should be paid to possible long-term sequelae in these patients.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.137-147
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• 2012

Purpose: Analyze the Effectiveness of Radiation Treatment Planning by dose calculation and optimization algorithm, apply consideration of actual treatment planning, and then suggest the best way to treatment planning protocol. Materials and Methods: The treatment planning system use Eclipse 10.0. (Varian, USA). PBC (Pencil Beam Convolution) and AAA (Anisotropic Analytical Algorithm) Apply to Dose calculation, DVO (Dose Volume Optimizer 10.0.28) used for optimized algorithm of Intensity Modulated Radiation Therapy (IMRT), PRO II (Progressive Resolution Optimizer V 8.9.17) and PRO III (Progressive Resolution Optimizer V 10.0.28) used for optimized algorithm of VAMT. A phantom for experiment virtually created at treatment planning system, $30{\times}30{\times}30$ cm sized, homogeneous density (HU: 0) and heterogeneous density that inserted air assumed material (HU: -1,000). Apply to clinical treatment planning on the basis of general treatment planning feature analyzed with Phantom planning. Results: In homogeneous density phantom, PBC and AAA show 65.2% PDD (6 MV, 10 cm) both, In heterogeneous density phantom, also show similar PDD value before meet with low density material, but they show different dose curve in air territory, PDD 10 cm showed 75%, 73% each after penetrate phantom. 3D treatment plan in same MU, AAA treatment planning shows low dose at Lung included area. 2D POP treatment plan with 15 MV of cervical vertebral region include trachea and lung area, Conformity Index (ICRU 62) is 0.95 in PBC calculation and 0.93 in AAA. DVO DVH and Dose calculation DVH are showed equal value in IMRT treatment plan. But AAA calculation shows lack of dose compared with DVO result which is satisfactory condition. Optimizing VMAT treatment plans using PRO II obtained results were satisfactory, but lower density area showed lack of dose in dose calculations. PRO III, but optimizing the dose calculation results were similar with optimized the same conditions once more. Conclusion: In this study, do not judge the rightness of the dose calculation algorithm. However, analyzing the characteristics of the dose distribution represented by each algorithm, especially, a method for the optimal treatment plan can be presented when make a treatment plan. by considering optimized algorithm factors of the IMRT or VMAT that needs to optimization make a treatment plan.

• Clinical and Experimental Pediatrics
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• v.45 no.6
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• pp.783-789
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• 2002

Purpose : We evaluated the epidemiologic characteristics and incidence of coronary artery sequele of children with KD according to treatment. Methods : We retrospectively analyzed 506 medical records of children with KD, who were admitted at Daejeon St. Mary's Hospital from Jan. 1987 to Dec. 2000. Results : The mean annual incidence was $36.1{\pm}11.1$ cases per year. There was a slightly higher occurrence in summer with no significant difference in monthly incidence. The mean age was $2.4{\pm}1.7$ years and 450 children(88.9%) were below four years of age. The male to female ratio was 1.7 : 1. When the 345 cases between 1987 and 1994 were divided into three groups according to treatment, incidences of the coronary abnormality(above grade II) of aspirin-treated(54 cases; 15.6%), divided-intravenous immunoglobulin(IVIG) treated($400-500mg/day{\times}4-5days$, 224 cases; 64.9%), and one-dose IVIG treated(2.0 g/day, 67 cases; 19.5%) groups were 8.3%, 6.0%, and 7.5%, respectively. Between 1995 and 2000, 143 cases were treated with only one-dose IVIG and 21 cases(14.7%) showed coronary artery abnormalities(grade I, 15 cases; grade II, two cases; and grade III, four cases). Among the 143 cases, 22 cases(15.1%) were retreated with IVIG and/or steroid pulse therapy. The incidence of coronary artery abnormality in this group was 50.0%. Incidences of cases in recurrence and among siblings were 0.6% and 0.4% respectively. There was no fatal case. Conclusion : In Daejeon, Korea, the epidemiologic feature of KD showed slight annual variations without monthly differences. The incidence of coronary abnormality with one-dose IVIG therapy was 14.7%. The nonresponse of this therapy was 15.1% with a coronary abnormality of 50.0%.

• Clinical and Experimental Pediatrics
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• v.51 no.3
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• pp.323-328
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• 2008

Purpose : Asthma is defined as chronic inflammation of the lower small airways, and bronchial hyperreactivity (BHR) is a pathophysiologic feature of asthma. It has been proposed that although there is no direct variable capable of assessing the small airways, a forced expiratory flow of between 25 and 75 percent ($FEF_{25-75}$) might be considered a more sensitive early marker of small airway obstruction than the forced expiratory volume in 1 second ($FEV_1$). Thus, we proposed that the presence and degree of positive responses to bronchial methacholine testing were related to the difference (DFF) and ratio (RFF) between $FEV_1$ and $FEF_{25-75}$ in asthmatic children. Methods : The subjects were 583 symptomatic children, including 324 children with BHR and 259 controls. Pulmonary function tests, methacholine challenge tests, and skin prick tests were performed, and the total eosinophil count, total serum IgE, and serum eosinophil cationic protein level were measured in all subjects. From a concentration-response curve, the methacholine concentration required to produce a decrease of 20% from post-saline $FEV_1$ was calculated ($PC_{20}$). Results : The median DFF and RFF values decreased in controls compared to subjects with bronchial hyperresponsiveness, and this trend was found in groups ranked by its severity. $PC_{20}$ had a negative correlation with DFF and RFF. Cutoff values of 0.5 for DFF and 1.042 for RFF were identified, and sensitivity and specificity were calculated. Conclusion : This study revealed that DFF and RFF might be predictive of bronchial hyperresponsiveness in the context of normal $FEV_1$ in children.