• Journal of Chest Surgery
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• v.42 no.5
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• pp.630-634
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• 2009

According to the 2007 International Society for Heart and Lung Transplantation (ISHLT) report, a congenital diagnosis, infantile transplantation and being on extracorporeal membrane oxygenation (ECMO) at the time of transplant are risk factors for mortality for the patients who undergo a heart transplant, and a large body weight ratio also increases the risk of mortality. The patient of this case underwent a Ross operation and mitral valve repair due to left ventricle outflow track obstruction and mitral regurgitation. But the baby was treated with ECMO due to heart failure after the operation. When he was 3-months-old and had been. on 30 days of ECMO, he underwent a heart transplant with a heart that had a high donor-recipient weight ratio (4.42). We present this case from a technical standpoint and we include a review of the relevant literature.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.2
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• pp.205-215
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• 2008

The purpose of this study is to evaluate at which stage of tooth germ would develop into normal calcification and hence to increase the success rate of transplantation. Therefore, tooth germs on the 15th, 17th embryonic day and the 3rd day of birth were separated for allotransplantation into maxilla of adult rat of 11 weeks. Calcification processes were analyzed radiographically and histopathologically at 4 weeks and 8 weeks after allotransplantation. The results are as follows: 1. Allotransplanted tooth germ at 4 weeks and 8 weeks showed delayed calcification compared to that of normal odontogenesis. 2. At 4 weeks, abnormal calcified tissue, such as odontoma and ankylosis of osteodentin with surrounding alveolar bone were observed. 3. At 8 weeks, allotransplanted tooth germs of the 15th and 17th embryonic day showed calcification and osteodentin surrounded by periodontal ligament. 4. At 8 weeks, allotransplanted tooth germs of the 3rd day of birth showed calcification composed of cementum and osteodentin. In this study, we observed small sized and amorphous calcified tissue from allotropic allotransplantation of tooth germs. Since these calcified tissue were underdeveloped and shaped irregularly, for calcification into normal tooth form, further study needs consideration about the reduction of surgical trauma, developmental stage of transplanted tooth germ, blood supply from recipient site, fixation method in transplanted site and period of transplantation.

• Childhood Kidney Diseases
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• v.15 no.1
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• pp.76-80
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• 2011

Cytomegalovirus (CMV) is the single most common infection following kidney transplantation and despite prophylactic strategies and the development of new antiviral agents, it still remains a cause of considerable morbidity and mortality. Current literature suggests that CMV infection may trigger rejection. We report a case of late CMV disease in a preemptive seropositive recipient who did not receive CMV prophylaxis. Diarrhea and abdominal cramping persisted after the administration of mycophenolate mofetil (MMF) six months after transplantation and resulted in ileal perforation at eight months after transplantation. The boy recovered after six weeks of treatment with ganciclovir. MMF has been mooted as a risk factor for CMV infection since its introduction, and further investigations are required to confirm its role. More attention to infectious complications is necessary and serial monitoring of viral load is recommended when MMF is administered.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.14 no.2
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• pp.111-120
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• 2018

The need for oral health rights for people with disabilities is very high, and current oral health care system does not fully reflect these demands. Efforts to promote oral health of people with disabilities are urgently needed. In order for the disabled to have oral health rights, access to oral health services for people with disabilities should be improved and barriers to access should be resolved. In this study, we propose oral health service delivery system to guarantee oral health rights for the disabled. In addition, before applying the proposed oral medical delivery system, the external effects of the system application were predicted and the expert verification was conducted to find out the solution. There are some controversies about the development of the service delivery system proposed in this study. As a result of the expert verification, there were disagreements about the suitability of the service provider, the suitability of the service recipient, the appropriateness of the service content and scope, and the appropriateness of the cost and the revenue source. Subsequent Delphi surveys require the development of structured questionnaires for discussions that require consensus. It is expected that a reasonable consensus of expert opinions will be derived.

• Clinical and Experimental Pediatrics
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• v.56 no.11
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• pp.490-495
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• 2013

Purpose: The use of cyclosporine and mini-dose methotrexate (MTX) is a common strategy for graftversus- host disease (GVHD) prophylaxis in allogeneic transplants. We investigated whether patients who receive fewer than the planned MTX doses are at increased risk for GVHD. Methods: The study cohort included 103 patients who received allogeneic transplants at the Department of Pediatrics of The Catholic University of Korea College of Medicine, from January 2010 to December 2011. MTX was administered on days 1, 3, 6, and 11 after transplant at a dose of 5 $mg/m^2$ each. Within the cohort, 76 patients (74%) received all 4 doses of MTX [MTX(4) group], while 27 patients (26%) received 0-3 doses [MTX(0-3) group]. Results: Although there was no difference in neutrophil engraftment between the 2 groups, platelet engraftment was significantly faster in the MTX(4) group (median, 15 days), compared to the MTX(0- 3) group (median, 25 days; P =0.034). The incidence of grades II-IV acute GVHD was not different between the MTX(4) and MTX(0-3) groups (P =0.417). In the multivariate study, human leukocyte antigen mismatch was the most significant factor causing grades II-IV acute GVHD (P =0.002), followed by female donor to male recipient transplant (P =0.034). No difference was found between the MTX(4) and MTX (0-3) groups regarding grades III-IV acute GVHD, chronic GVHD, and disease-free survival. Conclusion: Our results indicate that deviations from the full dose schedule of MTX for GVHD prophylaxis do not lead to increased incidence of either acute or chronic GVHD.

• Clinical and Experimental Pediatrics
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• v.46 no.1
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• pp.42-50
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• 2003

Purpose : The acute respiratory distress syndrome(ARDS), an acute form of severe alveolar-capillary injury evolving after a direct or indirect lung insult is thought to be a common cause of respiratory failure though not many clinical studies on the subject have been made yet. Methods : Between January 1992 and December 2001, we conducted a retrospective study on 33 children who fulfilled the definition of the ARDS recommended by the American-European Consensus Conference in 1994. Results : A total of 33 patients(20 boys and 13 girls) were selected. Their age ranged from 4 months to 12 years with seven children younger than 1 year. The overall mortality rate was 78.8% and no significant difference was noted based on age or sex. Concerning seasonal variation, incidence of the ARDS increased in spring, especially in May(21.2%). Pneumonia(66.7%) was found to be the most common risk factor of the ARDS followed by sepsis(24.2%) and aspiration(3.0%). In immune compromised children(six cases), including a recipient of bone marrow transplantation, the mortality rate was 100%. Compared with children with multiple organ failure recording a 83.3% mortality rate, those with isolated respiratory failure, showed a lower mortality rate of 33.3%, although stastistically insignificant. Between survivor and non-survivor groups, significant differences were shown in hematocrit, $PaO_2$, $PaCO_2$, PEEP, and $PaO_2/FiO_2$ on the seventh day after the onset of the ARDS. Conclusion : According to our study, respiratory failure proved to have a great effect on mortality rate in the ARDS. More aggressive intervention and further studies on this subject should be done to improve the survival rate.

• Clinical and Experimental Pediatrics
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• v.51 no.12
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• pp.1336-1341
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• 2008

Purpose : This study aimed to determine the frequencies of $CD4^+CD25^+$ T cells in donor graft and peripheral blood $CD4^+CD25^+$ T cells in recipients after hematopoietic stem cell transplantation (HSCT) and their association with graft-versus-host disease (GVHD). Methods : Seventeen children who underwent HSCT were investigated. $CD4^+CD25^+$ T cells in samples from donor grafts and recipient peripheral blood were assessed by flow cytometry at 1 and 3 months after transplantation. Results : $CD4^+CD25^+$ T cell frequencies in the grafts showed no significant difference between patients with and without acute GVHD (0.90% vs. 1.06%, P=0.62). Absolute $CD4^+CD25^+$ T cell number in grafts were lower in patients with acute GVHD than in those without acute GVHD ($6.18{\times}10^5/kg$ vs. $25.85{\times}10^5/kg$, P=0.09). Patients without acute GVHD showed a significant decrease in peripheral blood $CD4^+CD25^+$ T cell percentage at 3 months compared to those at 1 month after HSCT (2.11% vs. 1.43%, P=0.028). However, in patients with acute GVHD, $CD4^+CD25^+$ T cell percentage at 3 months was not different from the corresponding percentage at 1 month after HSCT (2.47% vs. 2.30%, P=0.5). Conclusion : The effect of frequencies of $CD4^+CD25^+$ T cells in donor grafts on acute GVHD after HSCT could not be identified, and the majority of peripheral blood $CD4^+CD25^+$ T cells in patients who underwent HSCT may be activated T cells related to acute GVHD rather than regulatory T cells. Further studies with additional markers for regulatory T cells are needed to validate our results.