• 대한두경부종양학회지
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• 제34권2호
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• pp.77-80
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• 2018

Subglottic cysts have been reported as a relatively rare problem of pediatrics who have a history of premature birth and period of intubation. They may cause significant upper airway obstruction and many cases require tracheostomy to airway management. Endoscopic marsupialization by microinstruments or laser has been standard primary treatment but a high recurrence rate has been reported. A 19-month-old child presented with stridor who has history of ventilation via an endotracheal intubation in the newborn period for 7 days. Radiologic examinations were performed for aggravated dyspnea symptom and subglottic cystic mass was found, then it was marsupialized at operation room and tracheostomy was done at the same time. After decannulation of tracheostomy tube, there is no recurrence of cyst nor upper airway obstruction for 29 months. We report this case with a review of literature.

• 대한장애인치과학회지
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• 제10권1호
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• pp.38-42
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• 2014

본 증례에서는 특별한 주의가 필요한 장애인을 위한 효율적이고 전문적인 의료 전달을 위해 여러 과와의 협의를 통한 진료가 필요함을 알리고 있다. 특히 기관절개관을 가진 환자의 마취관리와 치과치료를 시행함에 있어서 전신상태 및 기관절개관에 대한 이해와 주의가 필요하다. 1. 충치치료를 주소로 내원한 22세 남환에서 기관내삽관의 활용을 통해 전신마취 하에서 치과치료를 성공적으로 전달하였다. 2. 환자는 발작의 위험성을 가지고 있었으며, 안전한 치과치료를 위해 전신마취를 행동조절의 방법으로 선택하였다. 3. 기관내삽관에는 여러 종류가 있으며, 그 중 전신마취 하에 호흡보조를 할 수 있는 종류는 커프를 가진, 이중내강의 형태로 된 관이다. 따라서, 기관내삽관을 가진 환자에서 전신마취 하 치과치료를 진행하기 위해서는 기관내삽관의 형태에 대한 적절한 평가 및 처치가 선행되어야 한다.

• Clinical and Experimental Pediatrics
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• 제59권sup1호
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• pp.76-79
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• 2016

Tracheoinnominate artery fistula is a rare, fatal complication of tracheostomy, and prompt diagnosis and management are imperative. We report the case of tracheoinnominate artery fistula after tracheostomy in a 14-year-old boy with a history of severe periventricular leukomalacia, hydrocephalus, cerebral palsy, and epilepsy. The tracheoinnominate artery fistula was successfully treated with a stent graft insertion via the right common femoral artery. Endovascular repair of the tracheoinnominate artery fistula via stent grafting is a safe, effective, and minimally invasive treatment for patients in poor clinical conditions and is an alternative to traditional open surgical treatment.

• 대한후두음성언어의학회지
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• 제32권1호
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• pp.29-34
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• 2021

Background and Objectives Tracheostomy lead to persistent bacterial colonization of the respiratory tract. Surgical site infection and restenosis by the pathogenic bacteria is the most fatal complication after open airway surgery. The aim of this study is to describe the culture results of larynx and tracheostoma in patients with tracheostomy and the preoperative, intraoperative culture results in patients underwent open airway surgery. Materials and Method A retrospective review was performed on 18 patients who underwent culture between 2017 and 2019. Results Pseudomonas or antibiotic resistance bacteria were identified in 11 patients out of 18 patients (61.1%); Ceftriaxone-resistant Streptococcus (38.9%), Pseudomonas (33.3%), Methicillin-resistant Staphylococcus aureus (16.7%), extended-spectrum β-lactamases (ESBL) producing Klebsiella pneumoniae (11.1%). Among 18 patients, 6 patients showed the different culture result between larynx and tracheostoma. In 4 out of 10 patients who underwent open airway surgery, the bacteria were not identified before surgery, but the bacteria were isolated in the intraoperative culture. In one patient, the bacteria detected intraoperatively were different from those detected before surgery. Conclusion Preoperative respiratory tract culture and usage of perioperative antibiotics according to the culture are necessary. It is crucial to verify the bacterial culture in both tracheostoma and larynx. And it should be performed immediately before open airway surgery.

• Journal of Genetic Medicine
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• 제18권1호
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• pp.64-69
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• 2021

Primary cilium has a signal transduction function that is essential for brain development, and also determines cell polarity and acts as a mediator for important signaling systems, especially the Sonic Hedgehog (SHH) pathway. TBC1D32 is a ciliary protein, implicated in SHH signaling. Biallelic mutations in the TBC1D32 gene causes a kind of ciliopathy, heterogeneous developmental or degenerative disorders that affect multiple organs, including the brain. Here we report a boy who carried compound heterozygous variants in TBC1D32. The patient showed hypotonia, respiratory difficulty, and multiple anomalies at his birth. He was diagnosed with congenital hypopituitarism and treated with T4, hydrocortisone, and growth hormone. Despite the hormonal replacement, the patient needed long-term respiratory support with tracheostomy and nutritional support with a feeding tube. His developmental milestones were severely retarded. Hydrocephalus and strabismus developed and both required surgery, during the outpatient follow-up. Whole-exome sequencing indicated compound heterozygous variants, c.2200C>T (p.Arg734^*) and c.156-1G>T, in TBC1D32 gene. This is the first Korean case of TBC1D32-related ciliopathy and we reported detailed and sequential clinical features. This case demonstrated the utility of whole-exome sequencing and provided valuable clinical data on ultra-rare disease.

• Journal of Chest Surgery
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• 제40권8호
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• pp.569-573
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• 2007

기능성 단 심실, 폐동맥 폐쇄, 주 대동맥-폐동맥 측부 혈관, 총폐정맥 환류 이상이 동반된 우심방 이성체의 진단을 받은 여아가 청색증의 악화로 생후 3개월째 좌측 주 대동맥-폐동맥 측부 혈관 단일화 수술 및 좌측 변형 Blalock-Taussig 단락술을 시행하였다. 수술 후 흉부 x-ray 상 폐정맥 울혈의 소견을 보여 시행한 심장 초음파 검사 상 폐정맥 협착이 발견되어 총폐정맥 환류 이상에 대한 무 봉합 술식 및 우측 주 대동맥-폐동맥 측부 혈관에 대한 단일화 수술을 같이 시행하였다. 수술 후 저산소증으로 인한 심폐기 이탈 실패로 8일간 체외 막형 산화기로 보조하였으며, 전신-폐 단락술을 추가하면서 체외 막형 산화기를 이탈할 수 있었다. 환아는 장기간의 기관 삽관으로 유발된 기관 협착으로 기관지 절개를 한 상태에서 1차 수술 후 104일째 퇴원하였고, 산소 투여 없이 산소 포화도 80% 정도로 유지하면서 2개월째 외래 관찰 중이다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제8권2호
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• pp.252-256
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• 2005

저자들은 청색증, 복부 팽만을 주소로 내원한 생후 2일 된 남아에서 Haddad 증후군, 즉 결장 전체의 무신경절증 형태의 Hirschsprung병을 동반한 선천성 중추성 저환기 증후군 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한후두음성언어의학회지
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• 제31권2호
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• pp.92-95
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• 2020

Tracheal granuloma, the most commonly reported sequela of pediatric tracheotomy. A variety of techniques are available for the management of tracheal granuloma. Potassium-titanyl-phosphate (KTP) laser has been previously established as an acceptable technique for removal of laryngeal surgery, which emits a green light with a wave length of 532 nm, which is well-absorbed by hemoglobin and can coagulate and vaporize tissue. The ability to deliver laser energy through a flexible glass fiber makes the technique convenient for use with a rigid bronchoscope, overcoming problems with intraluminal access encountered with earlier attempts at CO2 laser therapy for this problem. Another advantage of KTP laser is the avoidance of the risks and morbidity associated with an open procedure. We report our surgical technique KTP laser in the management of tracheal granuloma removal into the tracheostomy site. KTP laser is good tool for management of tracheal granuloma with low incidence of complications.

• 대한후두음성언어의학회지
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• 제31권1호
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• pp.19-26
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• 2020

Background and Objective Endoscopic airway dilation is the primary treatment for pediatric subglottic stenosis (SGS) due to its feasibility and non-invasiveness. The aim of this study is to evaluate the risk factors for the failure of endoscopic airway dilation in pediatric patients with SGS. Materials and Methods This study reviewed medical records of 38 pediatric patients had endoscopic dilation from a single and tertiary referral center, retrospectively. The success of the endoscopic dilation procedure was defined as no dyspneic symptom without tracheostomy or laryngotracheal reconstruction. Demographic profiles, underlying disease, and Myer-Cotton SGS severity grade were recorded. Success rates and risk factors for the failure of treatment were analyzed. Results The SGS patients with severity grade I was most common. After mean 1.8 numbers of procedures, there were 23 patients (60.5%) in the success group and 15 patients (39.5%) in the failure group. Age, sex, underlying diseases, and SGS severity grade were not significantly different between two groups. In patients who had multiple endoscopic procedures, the failure group showed SGS deteriorated after procedures in 66.7%, compared to 11.1% of the success group. In multivariable analysis, a long-term intubation (≥1 month) was identified as an independent risk factor for failure of endoscopic dilation procedure. Conclusion Although endoscopic dilation procedure is safe and effective for the management, repetitive endoscopic dilation may not give clinical benefit in patient with long-term intubation. Other airway procedures must be considered in those group of patients.

• 대한간호학회지
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• 제13권3호
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• pp.1-33
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• 1983

The role and function of nursing care nowadays, tend to acquire sophisicated technology because specialization has expended due to increase of the medical population and the improvement of national health standards. To implement nursing care independently as a professional nurse, the apprehension of specific knowledge and skill should be acquired during basic nursing education. So it is important for nursing education not only to include theory and actual techniques, but also to strengthen the practical training in the actual clinical setting. This study was carried out with the following objectives; 1. To survey the detailed content and frequency of actual nursing students display during their clinical training. 2. To investigate the detailed content and frequency of actual nursing behavior which students display in each clinical a area. 3. To identify the motive for selection of nursing as their major and to determine the degree of self confidence, extent of knowledge and recognition of nursing responsibility. 4. To observe the relationship between actual nursing behavior and each of the following; 1) Motive for selecting nursing as a major 2) Self confidence 3) Knowledge of nursing care 4) Recognition of nursing responsibility The conclusions of this study were as follows; 1. Among the detailed nursing behavior which junior nursing college students carry out in clinical training; taking respiration's showed the highest frequency, and taking body temperatures, blood pressures, and pulses and making beds were next in frequency in this order. 2. In detailed nursing behaviors according to clinical area; taking vital signs showed the highest frequency in the emergency room, pediatric ward, orthopedic ward, general surgical ward and internal medicine ward. However, in the operating room, assisting with endotracheal tube insertion and sterile techniques were showen to have the highest frequencies. In nursery, umbilical cord care and the measurement of body weight were the highest in frequency In neurosurgical ward, the measurement of vital signs, changing position and tracheostomy care were the highest in frequency. In obstetric and gynecological ward and in the delivery room, checking duration, intensity and frequency of contractions was the highest in frequency. 3. In regard to the motive for majoring in nursing, the aptitude and interest of the student had the highest percentage(32.86%), and self-confidence in nursing activities (M=3.36), knowledge in nursing activities.(M=3. 09), and the recognition of the nursing activity (M= 3.76) wire in the middle range. 4. When the detailed nursing behaviors were compared with motive, self confidence, knowledge and recognition, it was found that when the nursing behavior was difficult and regarding much endeavor although the motive was high, the frequency of the nursing behavior was rather low. But in the cases in which there was much self confidence and a high level of skill was required, nursing behavior was carried more frequently. When there was muck self confidence and skill was not required, the frequency of nursing behavior was rather low. In the cases of a high level of knowledge, the frequency of nursing behavior was low and when recognition for nursing behavior was given the frequency of nursing behavior was low.