• Pediatric Infection and Vaccine
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• v.30 no.3
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• pp.152-158
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• 2023

Staphylococcus aureus (SA) is a common cause of skin and soft tissue infections. Panton-Valentine leukocidin (PVL) toxin-producing strain of SA has been discovered worldwide and is known to cause serious infections. However, reports of neonatal infections caused by PVL-positive SA are rare. Here, we report a case of severe skin and soft tissue infection caused by PVL-positive SA in a 7-day-old neonate. The patient was admitted to the emergency room with a history of fever for one day, tenderness, and sensation of buttocks heating. The infant presented with fever, tachycardia, poor general health, progressive tenderness, and edema of the buttocks on the day of admission. Ultrasonography and magnetic resonance imaging revealed necrotizing fasciitis involving the skin, soft tissue, and muscles. Specimens drained from the buttock lesions confirmed the presence of PVL-positive methicillin-resistant SA (MRSA), and there was no bacteremia. She recovered after one month of intravenous antibiotics and surgical drainages. One month after discharge, she was rehospitalized for otitis externa and was infected with MRSA again. Considering the PVL-positive strain, the patient was treated with intravenous linezolid and dressing. The patient underwent decolonization therapy in a 0.5% chlorhexidine bath and recovered completely without sequelae. This case suggests that aggressive drainage and antibiotic treatment are essential for PVL-producing MRSA infections, and additional decolonization is needed to prevent recurrence and community spread.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.826-830
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• 2002

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-Ⅹ valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.622-628
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• 2007

Purpose : While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. Methods : All children admitted from March 2006 to February 2007 to the POU at the Department of Pediatrics in Our Lady of Mercy Hospital were included in this study. Data were collected from retrospective reviews of their medical records. Results : There were a total of 1,076 POU admissions. Median age of patients was 2.4 years and median length of hospital stay 14.0 hours. The most common diagnoses were gastroenteritis (42.7%), pharyngotonsillitis (19.1%), bronchiolitis (7.8%), pneumonia (5.5%) and febrile seizure (5.2%). Overall, 7.5% of the POU patients required subsequent inpatient admissions due to hospital stays of longer than 48 hours. The disease entities that were most likely to require inpatient admission were pneumonia (17.0%), febrile seizure (12.5%) and asthma (11.5%). Diseases that allowed successful discharge from the POU were gastroenteritis (4.6%), upper respiratory tract infection (5.8%), such as otitis media and pharygnotonsillitis and seizure disorder (6.4%). Compared with the previous year when the POU was not in operation, there was a statistically significant reduction in the average length of hospital stays (from 4.69 to 3.75 days), as well as a rise in the bed turnover rate (from 78.8 to 98.2 patients/bed). Conclusion : Our study shows that the POU is efficient for the management of children with certain acute illnesses. Based on this study, we suggest that the POU be used as a new modality which links between the outpatient, inpatient, and emergency departments in the field of pediatrics in Korea.

• Journal of the Korean Society of School Health
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• v.9 no.1
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• pp.55-67
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• 1996

This research has incorporated a postal survey from the principals, nurse-charging teachers and nurse-teachers of the fiftyfive elementary, middle and high school in Yang-pyeong county area where its supplementary rate of nurse-teachers is less than adequate. It is to analyse the current status of the school health service in the area and to come out with a plan to improve the school health program through the participations of the health related experts of the local community. The survey was done in the two months of period of April to May of 1994. The result of the survey follows. The student population in the Yang-pyeong county area is 13,998 and the school employee population is 904 which counts for about 19.2% of the whole population of the area. However, the supplementary rate of nurse-teachers is only 10.8% (4 in 55 schools) which is very low in terms of relativity. School health committee only exist in 17% of the whole number of schools in the area and 50 of school health committee answered that their activity do not meet the adequate level. Only 54. 3% of the whole school numbers has included the school health finance in their financial plans and the amount set for the school health finance is about 500,000 wons (100,000-1,600,000 wons). 64.9% of the schools in the Yang-pyeong county area have the permanent nursing room established in the school. But, often than the equipment for a simple physical examinations, their supply of the health related equipments are less than adequate. Particitations of school doctor in the school health service is at only 67.6% which pretty much include only the physical examinations. Nurse-charging teachers consider their utmost important role is to teach health education but, they answered that they spent most of their times and efforts on physical examinations & immunizations. The average number of students visition to the nursing room is 2.5 persons and complains for basic discomfort as headache, concussion, stomachache and indigestion problems and usual pills used are the analgesics and digestives. Physical examination is done in the most schools every year but, 51.4% of nurse-charging teachers answered the physical examination does not really help. About the emergency treatment ability, 75.7% reports that both manpower & equipment are short. The school food services are present in only 8 schools (21.6%) but, 89.2% of nurse-charging teachers answer that there is a definite need of the food service. The survey says that the utmost important environmental health and safety factors are the traffic accidents followed by improper heat system, lighting, the stools and desks that do not consider the student physical status The overall evaluation of school health program reports that there are adequate physical examination, immunization, environmental hygiene, and management of safety but, on the other hand, health education, health councelling & management of nursing room are not managed properly. The principals of the survey pool report shortage of public agency support, lack of understanding of school health, shortage of nursing equipments and school health finance as the barrier factors of school health. The nurse-charging teachers report on the same questions as their less than qualitifying expertise, extraload of work upon the nursing affairs, shortage of nursing equipments & school health finance. The head masters & nurse-charging teachers answered that they are desperate for the meetings of nurse-charging teachers, construction of school health councelling system & training education in order to improve school health and if these are available, they will actively participate in them. After the careful analysis of the survey result, it is apparent that through the relations of the manpowers, establishment of community-oriented school health is definitely in need in rural area where there is low supplementary rate of nurse-teachers and poor school health environment.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.329-334
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• 2008

Background: Percutaneous cardiopulmonary support. (PCPS) has the potential to rescue patients in cardiogenic shock who might otherwise die. PCPS has been a therapeutic option in a variety of the clinical settings such as for patients with myocardial Infarction, high-risk coronary intervention and postcardiotomy cardiogenic shock, and the PCPS device is easy to install. We report our early experience with PCPS as a life saving procedure in cardiogenic shock patients due to acute myocardial infarction. Material and Method: From January 2005 to December 2006, eight patients in cardiogenic shock with acute myocardial infarction underwent PCPS using the CAPIOX emergency bypass system($EBS^{(R)}$, Terumo, Tokyo, Japan). Uptake cannulae were inserted deep into the femoral vein up to the right atrium and return cannulae were inserted into the femoral artery with Seldinger techniques using 20 and 16-French cannulae, respectively. Simultaneously, autopriming was performed at the $EBS^{(R)}$ circuit. The $EBS^{(R)}$ flow rate was maintained between $2.5{\sim}3.0L/min/m^2$ and anticoagulation was performed using intravenous heparin with an ACT level above 200 seconds. Result: The mean age of patients was $61.1{\pm}14.2$ years (range, 39 to 77 years). Three patients were under control of the $EBS^{(R)}$ before percutaneous coronary intervention (PCI), three patients were under control of the $EBS^{(R)}$ during PCI, one patient was under control of the $EBS^{(R)}$ after PCI, and one patient was under control of the $EBS^{(R)}$ after coronary bypass surgery. The mean support time was $47.5{\pm}27.9$ hours (range, 8 to 76 hours). Five patients (62.5%) could be weaned from the $EBS^{(R)}$ after $53.6{\pm}27.2$ hours. (range, 12 to 68 hours) of support. All of the patients who could successfully be weaned from support were discharged from the hospital. There were three complications: one case of gastrointestinal bleeding and two cases of acute renal failure. Two of the three mortality cases were under cardiac arrest before $EBS^{(R)}$ support, and one patient had an intractable ventricular arrhythmia during the support. All of the discharged patients are still surviving at $16.8{\pm}3.1$ months (range, 12 to 20 months) of follow-up. Conclusion: The use of $EBS^{(R)}$ for cardiogenic shock caused by an acute myocardial infarction could rescue patients who might otherwise have died. Successfully recovered patients after $EBS^{(R)}$ treatment have survived without severe complications. More experience and additional clinical investigations are necessary to elucidate the proper installation timing and management protocol of the $EBS^{(R)}$ in the future.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1981.05a
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• pp.5.3-6
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• 1981

There are too many kinds of esophageal corrosive agents, such as sodium hydrochloride, acetic acid, hydrochloric acid, etc. Esophageal burn due to above chemical agents are decreasing recently, but still many patients visited to the hospital because of swallowing corrosive agents for the purpose of suicide or accidentally. Among the treatment of corrosive injury of the esophagus, prevention of esophageal stricture is the key point. Recently various methods are using as the treatment of corrosive esophagitis and prevention of esophageal stricture. 51 cases of corrosive injury of the esophagus who had been admitted and treated at the Dept. of Otolaryngology, Han Yang University Hospital during past 9 years (from May 1972 to Dec. 1980) were evaluated and report the result about age distribution, sex incidence, monthly distribution, cause of swallowing, swallowing agents, arriving time at hospital after swallowing, changes on oral and pharyngeal mucosa, laboratory findings, emergency treatment and treatment during admission, treatment follow up results and complications with review of liter ature. Following results were obtained; 1. Female patients 27 cases (52.9%) were more than male patients 24 cases (47.1%) and its ratio was 1.13 : 1. 2. Age distribution showed predilection for age of 21-30 with 20 cases(39.2%), and 11-20 with 11 cases (21.6%), 31-40 with 7 cases(13.7%), over 50 with 7 cases (13.7%) were following. 3. Monthly distribution showed predilection for March with 8 cases(15.7%), and April, July with 7 cases (13.7%), September with 6 cases(l1.8%), October 5 cases(9.8%) were following. 4. For the purpose of suicide was the most cause of swallowing with 40 cases(78.4%), and accidentally swallowing 11 cases(21.6%). 5. Acetic acid was the most swallowing agent with 24 cases (47.0%), and hydrochloric acid 11 cases (21.5%), lye 8 cases(15.7%), iodine 2 cases(3.9%) were following. 6. Arriving time at the hospital after swallowing showed predilection for within 12 hours with 42 cases (82.4%), and from 12 hours to 24 hours with 4 cases(7.8%) was next. 7. Moderate change with injection and swelling was the prevalent change on oral and pharyngeal mucosa with 20 cases(39.2%) and severe cases with ulceration 18 cases (35.3%), mild cases with injection 10 cases (19.6%) were following. 8. Leukocytosis was seen on 40 cases (78.4%), and increased Hct. was seen 31 cases (60.8%). On urine analysis, 14 cases(27.5%) showed over 1.030 S.G., and proteinuria was seen on 25 cases(49.0%), glycosuria was seen on 5 cases(9.8%) and hematuria was seen on 6 cases(11.8). 9. Gastric lavage was done on 30 cases (58.8%) as emergency treatment and on 3 cases(5.9%) tracheostomy was done for the airway keeping. 10. As methods of treatment during admission, L-tube insertion was done on 50 cases (98.0%), antibiotics was given to 49 cases (96.1%), steroid and antacid were given to 46 cases(90.2%). 11. 36 cases(70.6%) were in favorable condition after proper treatment, but 2 cases (3.9%) were expired during admission, 4 cases (7.8%) showed esophageal stricture in-spite of treatment, and 1 case(2.0%) showed pyloric stenosis. 12. Complications were observed in 8 cases (17.7%). Renal failure (4 cases), aspiration pneumonia (2 cases), upper G-I bleeding (1 cases), and diabetic coma (1 cases) were seen in order of frequency.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.127-137
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• 1998

The authors surveyed extrafamilial sexual abuse in the children under 15years old by the physician's reports. We sent the semi-structured child sexual abuse questionnaires to 7055 board certified pediatrics, obstetrics and gynecology, family medicine and emergency medicine. Total respondents were 1205. The results from these respondents were as followings. 1) The number of respondents who have had the experience of treating victims of extraf/amilial child sexual abuse were 641(53.2% of total respondents). 2) 338(52.7%) of the perpetrators were known persons and 277(43.2%) were strangers, the most common age bracket were 20s, 30s and 10s, and almost all(99.8%) of the perpetrators were male. 3) The mean age of victims was $9.7{\pm}3.5$ years old, and almost all(98.6%) of the victims were female. 4) The ways by which extrafamilial child sexual abuses were found were victim’s own reports：273(62.6%), pain complaint, 156(24.3%) and abnormal behavior 96(15.0%), other person’s report 72(11.2%), detection during examination 19(3.0%), and pregnancy 4(0.6%). 5) Time lags between extrafamilial child sexual abuses and hospital visits were within 24 hours 332 (51.8%) and from 1 day to 1 week 232(36.2%), victims were rather quickly 6) Physical complications were perineal wound 571(89.1%), hymen rupture 349(54.4%), wound of other part of body 124(19.3%), pregnancy 37(5.8%), and sexually transmitted disease 18(2.8%), and other serious complications such as vaginal-rectal lacerations 8, intastinal bleeding 7, death 2, hypotensive shock 1. These results suggest considerable numbers of physicians have had the experience of treating victims of extrafamilial child sexual abuses, and extrafamilial child sexual abuses are the major medical as well as social issue in children in Korea.

• Sleep Medicine and Psychophysiology
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• v.22 no.1
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• pp.30-34
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• 2015

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.23 no.1
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• pp.25-30
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• 2023

Leigh syndrome is a rare progressive neurodegenerative mitochondrial disorder with clinical and genetic heterogeneity. Recently, balletic IARS2 variants have been identified in a number of patients presenting broad clinical phenotypes from Leigh and West syndrome to a rare syndrome CAGSSS characterized by cataracts, growth hormone deficiency, sensory neuropathy, sensorineural hearing loss, and skeletal dysplasia syndrome (OMIM#616007). We describe a child with Korean Leigh syndrome with urologic manifestations resulting from a compound heterozygote mutation in IARS2. A 5-year-old girl visited the emergency room with a complaint of abdominal pain accompanied by abdominal distension. Abdominal-pelvic CT showed a markedly distended urinary bladder without definite obstructive lesions. She was diagnosed with neurogenic bladder dysfunction based on a urodynamic study. She had global delayed development due to neurologic regression after 6 months of age and a history of bilateral cataract surgery at the age of 2 years. Her brain magnetic resonance imaging showed symmetrically increased signal intensities in the bilateral putamen and caudate nuclei with diffuse cerebral atrophy. No gene variants were identified through whole-mitochondrial genome analysis. Whole exome sequencing was performed for diagnosis, and compound heterozygous pathogenic variants were identified in IARS2: c.2446C>T (p. Arg816Ter) and c.2450G>A (p. Arg817His). To the best of our knowledge, this is the first case report of bladder dysfunction manifestation in a patient with IARS2-related Leigh syndrome. Thus, it broadens the clinical and genetic spectrum of IARS2-associated diseases.

• Journal of Intelligence and Information Systems
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• v.17 no.4
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• pp.143-155
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• 2011

Lately electronic tagging policy for the sexual offenders was introduced in order to reduce and prevent sexual offences. However, most sexual offences against children happening these days are committed by the tagged offenders whose identities have been released. So, for the crime prevention, we need measures with which we could minimize the suffers more promptly and actively. This paper suggests a new system to relieve the sexual abuse related anxiety of the children and solve the problems that electronic bracelet has. Existing bracelets are only worn by serious criminals, and it's only for risk management and positioning, there is no way to protect the children who are the potential victims of sexual abuse and there actually happened some cases. So we suggest also letting the students(children) wear the LBS(Location Based Service) and USN(Ubiquitous Sensor Network) technology based electronic bracelets to monitor and figure out dangerous situations intelligently, so that we could prevent sexual offences against children beforehand, and while a crime is happening, we could judge the situation of the crime intelligently and take swift action to minimize the suffer. And by checking students' attendance and position, guardians could know where their children are in real time and could protect the children from not only sexual offences but also violent crimes against children like kidnapping. The overall system is like follows : RFID Tag for children monitors the approach of offenders. While an offender's RFID tag is approaching, it will transmit the situation and position as the first warning message to the control center and the guardians. When the offender is going far away, it turns to monitoring mode, and if the tag of the child or the offender is taken off or the child and offender stay at one position for 3~5 minutes or longer, then it will consider this as a dangerous situation, then transmit the emergency situations and position as the second warning message to the control center and the guardians, and ask for the dispatch of police to prevent the crime at the initial stage. The RFID module of criminals' electronic bracelets is RFID TAG, and the RFID module for the children is RFID receiver(reader), so wherever the offenders are, if an offender is at a place within 20m from a child, RFID module for children will transmit the situation every certain periods to the control center by the automatic response of the receiver. As for the positioning module, outdoors GPS or mobile communications module(CELL module)is used and UWB, WI-FI based module is used indoors. The sensor is set under the purpose of making it possible to measure the position coordinates even indoors, so that one could send his real time situation and position to the server of central control center. By using the RFID electronic roll book system of educational institutions and safety system installed at home, children's position and situation can be checked. When the child leaves for school, attendance can be checked through the electronic roll book, and when school is over the information is sent to the guardians. And using RFID access control turnstiles installed at the apartment or entrance of the house, the arrival of the children could be checked and the information is transmitted to the guardians. If the student is absent or didn't arrive at home, the information of the child is sent to the central control center from the electronic roll book or access control turnstiles, and look for the position of the child's electronic bracelet using GPS or mobile communications module, then send the information to the guardians and teacher so that they could report to the police immediately if necessary. Central management and control system is built under the purpose of monitoring dangerous situations and guardians' checking. It saves the warning and pattern data to figure out the areas with dangerous situation, and could help introduce crime prevention systems like CCTV with the highest priority. And by DB establishment personal data could be saved, the frequency of first and second warnings made, the terminal ID of the specific child and offender, warning made position, situation (like approaching, taken off of the electronic bracelet, same position for a certain time) and so on could be recorded, and the data is going to be used for preventing crimes. Even though we've already introduced electronic tagging to prevent recurrence of child sexual offences, but the crimes continuously occur. So I suggest this system to prevent crimes beforehand concerning the children's safety. If we make electronic bracelets easy to use and carry, and set the price reasonably so that many children can use, then lots of criminals could be prevented and we can protect the children easily. By preventing criminals before happening, it is going to be a helpful system for our safe life.