• Pediatric Infection and Vaccine
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• 제14권1호
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• pp.55-61
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• 2007

목 적 : 열은 소아에서 매우 흔한 증상 중 하나이지만 부모들은 열 자체를 위험한 질환으로 인식하는 경우가 많다. 열에 대해 올바로 아는 것은 부모의 불필요한 염려를 덜고 환아의 질환과 진단 및 치료 과정을 이해하는데 도움을 줄 것이다. 이에 저자들은 소아의 열에 대한 부모들의 인식을 조사하고 과거와 비교하여 변화가 있는지 알아보고자 하였다. 방 법 : 2006년 5월부터 7월까지 3개월 동안 가톨릭대학교 성바오로병원 소아과 외래를 방문한 소아의 보호자들에게 열에 대한 지식, 태도, 대처 방법을 묻는 19문항의 설문조사를 실시하였다. 결 과 : 136명이 답하였으며 10년 전에 비하여 열에 대한 정보, 태도, 대처 방법 등에서 크게 개선된 점이 없었다. 열에 대한 기본 지식인 열의 기준과 측정 방법에 대해서 잘못 알고 있는 보호자가 많았고, 열성경련과 뇌손상의 가능성에 대한 염려는 여전히 지속되고 있었다. 열은 항상 해롭고 위험한 것이라고 생각하고 있었으며, 따라서 치료가 필요하지 않은 체온에서도 실제보다 심각한 결과를 걱정하며 해열제를 투여하고 병원에 방문하고 있음을 보여주었다. 결 론 : 보호자들은 열이 이로운 점을 가진 생리 반응중의 하나라는 사실을 인식하지 못하고 실제보다 심각한 결과를 예상하며 따라서 불필요한 우려와 치료를 택하게 된다. 이런 잘못된 인식은 시간의 경과에도 불구하고 큰 변화가 없었으며 따라서 소아과 의사들의 역할이 중요하다고 할 수 있다. 부모들에게 해열제를 사용하도록 할 때는 열이 해롭지 않으며 해열제의 목적은 열로 인한 아이의 불편감을 덜어주는 것임을 반복하여 알려주고, 더 나아가서는 소아과 의사들이 좀 더 체계적인 정보 및 교육 프로그램을 제공한다면 열에 대한 올바른 인식 형성에 도움이 되리라고 생각된다.

• 대한장애인치과학회지
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• 제8권1호
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• pp.10-14
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• 2012

자폐증 및 정신 지체가 있는 환자의 입술 깨물기 증상을 mouthguard를 사용하여 성공적으로 조절하였다. 치과적으로 접근 가능한 구강 내 자해 증상의 치료는 가철성 혹은 고정성 장치를 이용하거나 관련 치아의 발치, 악교정 수술 등을 시도할 수 있으며 각 환자에 맞는 적절한 치료법을 선택하는 것이 중요하다. 자해 행동이 일시적으로 개선되었다 해도 재발의 가능성이 높으므로 장기적인 관리와 소아정신과와의 협진 하에 정신심리학적 환경 개선 및 약물 치료가 병행되어야 할 것이다.

• 대한기관윤리심의기구협의회지
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• 제1권1호
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• pp.5-21
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• 2019

Purpose: Institutional review board (IRB) classifies risks of clinical trials into less than minimal risk, minor increase over minimal risk, and more than minimal risk. Based on classification and evaluation for risk, IRB decides whether permitting consent exemption or asking additional protection for clinical research subject or not. The purpose of this study is to analyze how IRB members evaluate minimal risk by sending questionnaire survey with 12 predetermined scenarios. Methods: IRB members and researchers (pediatrician, gastroenterologist, neurologist, and neurosurgeon) in 11 different hospitals were asked to answer survey questions via email or online. We analyzed the differences of answers among several subgroups in each predetermined scenarios. Result: Responders were 212 personnel(110 researchers and 102 IRB members) from 11 centers. There were significant differences between IRB members and researchers in response such as blood sampling, skin prick test, one time catheterization in a girl, spinal tapping in child, non-enhance MRI in child, non-enhance MRI with chrolal hydrate in a child, spinal tapping without anesthesia in adult, bioequivalence test, gastric endoscopy, and non-enhance CT. significant differences between medical IRB members and non-medical members were also revealed in one time catheterization in a girl, spinal tapping in a child, non-enhance MRI in a child, bioequivalence test. Depending on researchers' department, they responded differently in several questionnaires as well. Conclusions: We have found that IRB members and researchers evaluate the risks differently. Researchers compared to IRB members, medical IRB members compared to non-medical members answered less than minimal risk in many cases. In assessing and evaluating the risks associated with the study, medical IRB members answered predetermined scenarios as less dangerous compared to non-medical IRB members. Difference among researchers where also revealed significantly. Researchers answered predetermined scenarios as less dangerous compare to other department researchers, especially in predetermined scenarios containing procedures they are familiar with.

• Journal of Chest Surgery
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• 제17권1호
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• pp.118-124
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• 1984

Congenital Cystic Adenomatiod Malformation (C.C.A.M.) is rare, but one of the most common congenital pulmonary anomalies that cause acute respiratory distress in the newborn infants. It is characterized and differentiated from the diffuse pulmonary cystic disease pathologically, i.e. adenomatoid appearance due to marked proliferation of the terminal respiratory components. An 2/12 year old male patient was suffered from respiratory distress and cyanosis on crying since birth, but no specific therapy was given. With progression of symptoms, he came to Korea University Hospital for further evaluation and then transfered to Dept. of Chest Surgery for operative correction under the impression of Congenital Obstructive Emphysema suggested by a pediatrician. On gestational and family history, there was nothing to be concerned such as congenital anomaly. Physical examinations showed; moderate nourishment and development (Wt. 5.5kg), cyanosis on crying, both intercostal and lower sternal retraction on inspiration, Lt. chest building with tympany, Rt. shifting of cardiac dullness, decreased breathing sound with expiratory wheezing on entire Lt. lung field, decreased breathing sound on Rt. upper lung filed, and tachycardia. The remainders were nonspecific. Laboratory findings were normal except WBC $14000/mm^3$ (lymphocyte 70%), Hgb 9.8m%, Hct 28%, negative Mantaux test, and sinus tachycardia and counter-clockwise rotation on EKG. Preoperative simple Chest PA revealed marked hyperlucent entire Lt. lung, herniation of Lt. upper lobe to Rt., collapsed Rt. upper lobe, tracheal deviation and mediastinal shifting to Rt., and no pleural reaction. At operation, after Lt. posterolateral thoracotomy, 4th rib was resected. Operative findings were severe emphysematous changes limited to both lingular segmentectomy was done. The resected specimen showed slight solidity, measuring $8{\times}4.5{\times}2cm$ in size, and small multiple cystic spaces filled with air. Microscopically, entire tissue structures were glandular in appearance, cyst were lined by ciliated columnar epithelium, and occasional cartilages were noted around the cystic spaces. Bronchial elements were dilated but normal pattern on histologically. The patient had a good postoperative courses clinically and radiologically, and discharged on POD 10th without event. The authors report a case of Cogenital Cystic Adenomatoid Malformation (C.C.A.M.)

• Pediatric Infection and Vaccine
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• 제10권2호
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• pp.178-185
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• 2003

목 적 : 소아과 의원을 방문한 인두염 환자에서 A군 연쇄구균 분리율을 살펴보고자 하였다. T 항원형과 emm 유전자형을 동정하여 역학적 특성을 살펴보고, 같은 지역의 보균자 결과와 비교하고자 하였다. 방 법 : 2001년 11월부터 2002년 5월까지 경남 진주시에 위치한 한 소아과 의원에서 인두염 환자 246명(남자 123명, 여자 123명)을 대상으로 인후배양을 시행하였다. 슬라이드 응집법으로 T 항원형을 결정하였고, emm 유전자 증폭 후 염기서열 분석을 시행하여 emm 유전자형을 동정하였다. 결 과 : 인두염 환자 246명 중 130명(52.8%)에서 베타용혈성 연쇄구균이 분리되었으며, 그 중 96.1%가 A군이었다. 연령별로는 4세에서 7세가 70.4%로 가장 많았다. T12가 35.2%로 가장 흔하였고, T non-typeable 30.4%, T28 14.4% 순이었다. emm12(28.5%)가 가장 많이 동정되었고, emm75(18.7%), emm22(13.0%), emm2(12.2%) 및 emm8(8.1%) 순이었다. 결 론 : A군 연쇄구균 인두염은 약 50%에서 분리될 정도로 흔하므로, 개인 소아과 의원에서 급성인두염 환자에 대해 항생제 처방 전에 인후배양이 필요할 것으로 사료된다. T항원 및 emm 유전자형은 급성 인두염 환자와 보균자에서 비슷한 분포를 보였다.

• 대한장애인치과학회지
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• 제13권1호
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• pp.33-36
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• 2017

뇌성마비 환자들은 식이자세와 잇솔질에 대해 스스로 행동할 수 없기 때문에 의과적 치과적인 문제에 더 취약할 수 밖에 없다. 낮은 사회경제적 지위와 심각한 운동장애를 가진 뇌성마비 환자들은 특히 치과치료에서 소외되기 쉽다. 의과적 치료와 함께 구강관리는 뇌성마비 환자들의 삶의 질에 매우 중요한 관련이 있다. 그러므로, 장애인들의 삶의 질을 향상시키고 의료혜택으로부터 소외되지 않도록 정기적인 검진과 예방치료를 받기 위해서는 국가차원에서 공공의료서비스 및 시스템이 필요하다.

• Journal of Chest Surgery
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• 제12권3호
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• pp.281-288
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Journal of Chest Surgery
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• 제12권3호
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• pp.289-296
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• 1979

For years, physicians and anatomists have been interested in the heart that has one functioning ventricle. Various terms have been suggested for this entity including single ventricle, common ventricle, double-inlet left ventricle, cor biatriatum triloculare, and primitive ventricle. In this report, the term "single ventricle" is utilized as suggested by Van Praagh, and is defined as that congenital cardiac anomaly in which a common or separate atrioventricular valves open into a ventricular chamber from which both great arterial trunks emerge. An outlet chamber, or infundibulum, may or may not be present and give rise to the origin of either of the great arteries. This definition excludes the entity of mitral and tricuspid atresia. An 11 year old cyanotic boy was admitted chief complaints of exertional dyspnea and frequent upper respiratory infection since 2 weeks after birth. He was diagnosed as inoperable cyanotic congenital heart disease, and remained without any corrective treatment up to his age of 11 year when he suffered from aggravation of symptoms and signs of congestive heart failure for 2 months before this admission. On 22nd of May 1979, he was admitted for total corrective operation under the impression of tricuspid atresia suggested by a pediatrician. Physical check revealed deep cyanosis with finger and toe clubbing, and grade V systolic ejection murmur with single second heart sound was audible at the left 3rd intercostal space. Development was moderate in height [135 cm] and weight[28Kg]. Routine lab findings were normal except increased hemoglobin [21.1gm%], hematocrit [64 %], and left axis deviation with left ventricular hypertrophy on EKG. Cardiac catheterization and angiography revealed 1-transposition of aorta, pulmonic valvular stenosis, double inlet of a single ventricle with d-loop, and normal atriovisceral relationship [Type III C solitus according to the classification of Van Praagh]. At operation, longitudinal incision at the outflow tract of right ventricle in between the right coronary artery and its branch [LAD from RCA] revealed high far anterior aortic valve which had fibrous continuity with mitral annulus, and pulmonic valve was stenotic up to 4 mm in diameter positioned posterolaterally to the aorta. Ventricular septum was totally defective, and one markedly hypertrophied moderator band originated from crista supraventricularis was connected down to the imaginary septum of the ventricular cavity as a pseudoseptum of the ventricle. Size of the defect was 3X3 cm2 in total. Patch closure of the defect with a Teflon felt of 3.5 x 4 cm2 was done with interrupted multiple sutures after cut off of the moderator band, which was resutured to the artificial septum after reconstruction of the ventricular septum. Pulmonic valvotomy was done from 4 mm to 11 mm in diameter thru another pulmonary arteriotomy incision, and right ventriculotomy wound was closed reconstructing the right ventricular outflow tract with pericardial autograft of 3 x 4 cm2. Atrial septal defect of 2 cm in diameter was closed with 3-0 Erdeck suture, and atrial wall was sutured also when rectal temperature reached from 24`C to 35.5`C. Complete A-V block was managed with temporary external pacemaker with a pacing rate of 110/min. thru myocardial wire, and arterial blood pressure of 80/50 mmHg was maintained with Isuprel or Dopamine dripping under the CVP of 25-cm saline. Consciousness was recovered one hour after the operation when his blood pressure reached 100 /70 mmHg, but vital signs were not stable, and bleeding from the pericardial drainage and complete anuria were persisted until his heart could not capture the pacemaker impulse, and patient died of low output syndrome 320 min after the operation.

• Childhood Kidney Diseases
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• 제14권2호
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• pp.195-202
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• 2010

목 적 : 요로감염 환아에서 영구적 신장손상을 예측하기 위하여, 연령, 발열기간 및 농뇨 지속기간, 방광요관역류나 수신증 여부 등을 비교, 분석하였다. 방 법 : 2000년 1월부터 2005년 1월까지 아주대학교 병원에서 요로감염으로 입원한 환아 중 DMSA에서 신장 결손을 보인 160명의 환아를 대상으로 6개월 후 추적 DMSA에서 회복된 회복군과 반흔이 남은 반흔군으로 나누어 각각의 특징을 비교분석하였다. 결 과 : 전체 대상 환아 160명 중 106명이 추적 DMSA에서 회복을 보였고, 54명이 반흔이 남아 33.8%의 발생률을 보였다. 반흔군에서 처음 진단 당시의 나이가1세 이상인 환자가 회복군에 비해 많았고(P=0.01), 발열기간, 농뇨지속 기간 등이 회복군에 비해 길었으며, 발열의 기왕력이 있었다. VCUG, Ultra-sound sonography에서도 반흔군이 회복군에 비해 비정상적 결과를 보인 경우가 많았다. 결 론 : 급성신우신염을 앓은 소아에서 감염당시 환아의 나이가 많을수록, 발열 기간이나 농뇨 지속 기간이 오래 될수록, 방광요관역류나 초음파검사 이상소견이 있는 초기 신결손이 신반흔으로 고착되는 경향을 확인할 수 있었다. 특히 잦은 발열 기왕력이 있는 경우 신손상 발생률이 높은 것을 볼 때, 이는 임상에서 미처 진단되지 못한, 혹은 잘 못 진단된 급성신우신염이 있음을 시사해 준다.

• 모자간호학회지
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• 제4권1호
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• pp.3-11
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• 1994

Presently there is an increasing demand for home health care services due to changes in the demographic structure as a result of an increasing elderly population, socio-economic improvements, and changes in the family structure, as well as the growing number of people with degenerative diseases. In addition to these reasons, rising medical costs and there a shortage of patient beds space in the hospital, particularly since introduction of national medical insurance. There has been an increasing demand for health care health care services. This study was done to identify the basic data for home health care management. It focused on developing client selection criteria, assessment tools, and recording methods. This was accomplished by the researchers visiting the patients in their homes. The research process included preparation investigation, tool development, training of the project researcher, and visiting the clients in their homes. The research tools are as follows : 1. Record development : a) The selection criteria tool for home health care of postpartum women was a structured tool and consisted of four parts. b) The structured assessment tool consisted of a general items, obstetric history, past medical history, methods of feeding, medications taken before admission, laboratory test results, discharge instructions, discharge medications, family tree, economic status, environmental status, a map, health assessment of postpartum women and their newborns. c) The visit note I consisted of the frequency of visits. Visit note II consisted of the date ; nursing problems ; nursing process including the initial assessment ; nursing goal ; visit plan ; postpartum women and their neonate health status, diagnosis, goal, implementation, evaluation, summary, next plan, for visit revision. d) Problem note consisted of the date, problem numbers, nursing diagnosis, problem appearance date problem resolution date. The research results are as follows : 1. Nursing problems : The nursing problems of the postpartum women and their neonates were evaluated by the number of nursing diagnoses and the change in the pattern of nursing diagnosis related to the number of visits. a) Nursing diagnosis The nursing diagnosis was classified according to physical function, psychosocial function, family system maintained function. b) The changes of nursing diagnosis related to the number of visits. As the type of nursing diagnosis changed related to the number of visits the number of nursing diagnoses decreased. 2. Contents of home health care : The content was categorized according to assessment, direct care, counseling, education, family care, reporting to with the attending doctor. The recommendations based on the research results are as follows : 1. Tool development Replication of this study is needed to test the validity of the assessment tools used. 2. Home visit a) Home health care nurses should be licensed and qualified. A referral form from the attending doctor is needed for legal protection of nurses. b) The first home visit need to be within 24 hours of discharge from the hospital to decrease the anxiety of frightened postpartum women. c) When the changes occur in the newborn's status, home health care nurses should consult a pediatrician. Communication within the home healthcare team is essential and needs to consistent and done smoothly. 3. Home health care A Study is required to develop protocols for education of staff and for operation of all aspects of this program.