• Childhood Kidney Diseases
• /
• v.1 no.1
• /
• pp.17-23
• /
• 1997

After the first description of IgA nephropathy by Berger in 1968, the prognosis of this disease was considered favourable. However recent studies have revealed that IgA nephropathy result in end stage renal desease in 25-30% by 20 years. Heavy proteinuria, hypertension, histological high class are regarded as poor prognostic factors. In 1996, Yagame et al reported the new histopathologic grading with a strong correlation between the grading, heavy proteinuria, high s-Cr level and renal survival. The aims of this study are to determine whether the pathological grading and other clinical parameters could contribute to predicting the outcome of this disease eventhough pediatric patients. Seventy nine patients (59 males, 20 females) with IgA nephropathy were examined. Patients were 2.08-15.17 years of age ($9.85{\pm}2.83$). The mean follow-up duration were $27{\pm}28$ months. Six of seventy nine patients progressed to chronic renal failure during the follow-up periods. High 24h urinary protein excretion at diagnosis were significantly higher in chronic renal failure patients (p<0.05). Hypertension at diagnosis were the significant associated factors in progression of chronic renal failure (p<0.05). Histological changes of IgA nephropathy in light microscopy were classified into five classes by WHO classification, four grades in Yagame's gradings. Among the seventy nine patients, 24 were as class 1, 30 as class 2, 23 as class 3; 4 as class 4, 0 as class 5 by WHO classification. 23 were classified grade 1, 31 as grade 2, 24 as grade 3, 1 as grade 4 by Yagame's grading. Among six patients who progressed to chronic renal failure, 1 clssified as class 1, 1 as class 2, 3 as class 3, 1 as class 4, 0 as class 5 by WHO Classification. 1 patients were classified as grade 1, 1 as grade 2, 3 as grade 3, 1 as grade 4 by Yagame's grading. (p>0.05) In conclusion, hypertension and heavy proteinuria at initial presentation were significantly associated with progression of chronic renal failure. The classification of WHO & Yagame's grading has no significant association with the progression of chronic renal failure in pediatric patients.

• Childhood Kidney Diseases
• /
• v.11 no.1
• /
• pp.32-40
• /
• 2007

Purpose : We performed this study to determine the incidence of acute renal failure(ARF) in birth asphyxia and to correlate the severity of asphyxia and hypoxic-ischemic encephalopathy (HIE) and ARF in asphyxiated neonates. Methods : Data was retrospectively collected from the medical records of 33 patients with neonatal asphyxia and of 33 neonates with no asphyxia. On the basis the 5-minute Apgar score, the asphyxiated neonates were further grouped into mild(6 or 7), moderate(4 or 5), and severe asphyxia(3 or less). Asphyxiated neonates with HIE were staged by the Sarnat and Sarnat scoring system. We compared serum creatinine, blood urea nitrogen, electrolytes, and urine output on day 3 of life and the incidence and severity of intraventricular hemorrhage(IVH) between each group. Results : ARF occurred in 8(24.2%) asphyxiated neonates. Of these, 3(37.5%) were oliguric, while 1(10.0%) patient with mild asphyxia, 2(18.2%) of moderate asphyxia, and 5(41.7%) with of severe asphyxia had ARF(P>0.05). One(25%) patient with stage I HIE, 4(50%) with stage II HIE, and 3(75%) of HIE with stage III HIE developed ARF(P<0.01). There was no statistical correlation between the severity of asphyxia and HIE stage. One(7.7%) patient with grade 1 IVE, 0(0.0%) with grade 2 IVH, 2(66.7%) with grade 3 IVH, and 2(100.0%) with grade 4 IVH had ARF(P<0.01). Mortality was higher in asphyxiated neonates with ARF(P<0.05). There was no significant difference between the oliguric and non-oliguric renal failure. Conclusion : We found that the greater the degree of HIE, the higher was the incidence of ARF. Asphyxiated neonates with ARF had a poorer prognosis.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.14 no.1
• /
• pp.24-27
• /
• 2010

Purpose: Early diagnosis of breast is of the utmost importance to improve prognosis. We have a limitation for mammography and sonography detecting small cancer. Clinical importance of Breast Specific Gamma Imaging (BSGI) has improved for that reason. So We studied performance evaluation test of count rate and resolution with high sensitivity to the low dose of BSGI. Materials and Methods: BSGI of Dilon 6800, point source of $^{99m}Tc$ from 1.85~148 MBq (0.05~4 mCi) at the intervals of 1.85~37 MBq (0.05~1 mCi) was used for the test. Performance evaluation method was performed for measuring deadtime for choosing at the 5 different point in the useful field of view (UFOV), acquired image for 60 seconds. Compared with reference of clinical uptake distribution of breast, activity increased according to the distance change 10, 20, 30, 40, 50 mm in the useful field of view. Results: Counting curve increased according to the activity from 1.85 MBq (0.05 mCi) to the 74 MBq (2 mCi), and it change flat shape over 74 MBq (2 mCi). The variation of the full width of half maximum (FWHM) to the distance is 4.05, 4.73, 5.77, 6.90, 8.00, 9.32 mm in 1.85 MBq (0.05 mCi), 4.30, 4.80, 5.90, 7.00, 8.10, 9.07 mm in 3.7 MBq (0.1 mCi), 4.90, 5.60, 6.20, 7.20, 8.20, 9.10 mm in 5.55 MBq (0.15 mCi), 5.30, 6.10, 6.60, 7.00, 7.90, 8.70 mm in 7.40 MBq (0.2 mCi). Conclusion: Distortions of image would be acquired because of the deadtime in BSGI. We found out the fact that specification of $^{99m}Tc$ reaction under 74 MBq (2 mCi) for BSGI. Second, FWHM distribution change from varied distance from the detector, clearly distinguished the location of the lesion.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.8 no.2
• /
• pp.157-163
• /
• 2005

Purpose: Dietary protein induced proctocolitis (DPIPC) can be considered as a cause of rectal bleeding or blood streaked stool in otherwise healthy-looking infants in the first several months of life. Failure to appreciate this entity may lead to inappropriate diagnostic or therapeutic intervention. This study aimed to ascertain the clinical features, treatment and prognosis of DPIPC. Methods: We reviewed 13 infants retrospectively, presented with bloody stool in early infancy. They were diagnosed as DPIPC clinically in Pusan National University Hospital from May 2002 to June 2004. Results: Seven males and six females were included. The mean age at onset of bleeding was $96.8{\pm}58.8days$. The mean frequency of hematochezia was $2.6{\pm}2.5$ times a day. Duration from onset of symptom to diagnosis was $35.5{\pm}55.0days$ and duration from onset of symptom to resolution of bleeding was $58.7{\pm}67.0days$. Nine (69.2%) were exclusively breast-fed infants and two (15.4%) were formula-fed infants. All but one infant did not have family history of other allergic diseases. A dietary history of ingestion of cow's milk, nut or shellfish was present in three mothers. Peripheral eosinophil count was normal to slightly elevated (total WBC count $10,555{\pm}3,145/mm^3$, relative eosinophil count $6.3{\pm}3.0%$, absolute eosinophil count $659.0{\pm}532.2/mm^3$). Sigmoidoscopy revealed lymphonodular hyperplasia with surrounding hemorrhagic spots in the rectosigmoid colon in 6 infants. Histopathologic finding of colonic biopsies in 5 infants showed chronic inflammation with lymphoid follicular hyperplasia (5 infants), crypt abscess (3 infants), or mild infiltration of eosinophils (less than 20/high power field) in the lamina propria. Spontaneous resolution of rectal bleeding occurred in all infants without dietary change or medicine. Conclusion: Most infants with DPIPC experience a very benign course and have spontaneous resolution of rectal bleeding without changes in the mother's diet. In the case of strong evidence for DPIPC we suggest deferring further invasive investigation and continuing breast feeding.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.6 no.2
• /
• pp.129-139
• /
• 2003

Purpose: The aim of the study was to evaluate the long-term outcome of glycogen storage disease (GSD) type 1 with particular reference to hepatic adenoma and hepatocellular carcinoma, and to analyze risk factors affecting the development of hepatic adenoma in GSD type 1. Methods: Forty-three GSD type 1 patients (31 males and 12 females, mean age $13.9{\pm}6.4$ years) were analyzed retrospectively. Hepatic adenoma was detected on abdominal USG and diagnosed on histologic examination. Clinical profiles were compared between patients with hepatic adenoma (n=16) and age-matched controls without hepatic adenoma (n=16). Results: 1) Of 43 GSD type 1 patients, 16 (37.2%) had hepatic adeoma. Hepatic adenoma was detected at the age of mean $14.2{\pm}4.1$ years (range: 7.9~25.7 years). Fourteen (87.5%) adenomas were multiple at detection. 2) Comparison of the clinical profiles between adenoma group and non-adenoma group revealed that age at first introduction of uncooked cornstarch treatment was significantly late in adenoma group compared with non-adenoma group ($9.1{\pm}5.2$ years vs. $3.0{\pm}1.8$ years, p=0.003). Portocaval shunt surgery was performed in 11 (68.8%) patients in adenoma group and 3 (18.8%) in non-adenoma group (p=0.004). Hepatic adenoma developed mean $5.8{\pm}4.2$ years after shunt operation. 3) One patient was diagnosed as hepatocellular carcinoma at the age of 25.7 years. Conclusion: Hepatic adenoma is an important late complication of GSD type 1 with the risk of malignant transformation. Early introduction of cornstarch therapy with strict metabolic control is needed to prevent the development of hepatic adenoma in GSD type 1.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.11 no.2
• /
• pp.116-121
• /
• 2008

Purpose: Cricopharyngeal incoordination is a rare cause of swallowing difficulties in newborns and infants; it is characterized by delayed pharyngeal contractions related to cricopharyngeal relaxation. Dysphagia and repeated aspiration are common findings despite normal sucking. We conducted this study to assess the clinical features of cricopharyngeal incoordination in newborns and infants. Methods: An analysis of the clinical data from 17 patients with cricopharyngeal incoordination who were admitted to the Department of Pediatrics, Pusan National University Hospital, between 2000 and 2006 was conducted retrospectively. The diagnosis of cricopharyngeal incoordination was established by the clinical characteristics and the videofluoroscopic swallowing studies. Results: The male to female ratio was 1:1.1 (males 8, females 9) the age range 1 to 60 days. The body weight of 11 patients (64.7%) was less than the $10^{th}$ percentile at diagnosis. Six patients (35.3%) were born prematurely. The associated anomalies or diseases were chromosomal anomaly (2 cases), congenital heart disease (3 cases), and laryngomalacia, hypoxic brain damage or neonatal seizures (1 case each). The chief complaints of patients were recurrent aspiration pneumonia (10 cases), feeding difficulty (9 cases), dyspnea (4 cases), and chocking (4 cases). The severity of aspiration on the videoesophagogram or esophagogram was mild in 12 cases. The correlation between the severity of aspiration and the duration of tube feeding after the diagnosis was significant (p<0.05). Conclusion: Cricopharyngeal incoordination should be considered in the differential diagnosis of newborns and infants, without known risk factors associated with swallowing dysfunction, when they present with unexplained respiratory problems. Although the prognosis of cricopharyngeal incoordination is good, early diagnosis and tube feeding are recommended to prevent the complications associated with this disorder.

• Pediatric Infection and Vaccine
• /
• v.10 no.2
• /
• pp.208-214
• /
• 2003

Purpose : We performed a retrospective study on bacterial meningitis in children, pertaining to the causative organisms, bacterial resistance to antibiotics and the effect of recent introduction of Haemophilus influenzae type b(Hib) vaccine. Methods : We analysed the forty-three cases of bacterial meningitis which had been treated at the Inha University Hospital from June 1996 to June 2003. Results : Nineteen cases(44.2%) of them were infants younger than 2 months of age, and 29 cases(67.5%) younger than 1 year of age. The common causative organisms under 2 months of age were group B streptococcus(GBS)(47.4%), E. coli(21.1%), and Klebsiella pneumoniae(21.1%). In the age group beyond 2 months of age, S. pneumoniae were seen in 50 %, H. influenzae in 16.7% and N. meningitidis in 16.7%. All of the five cases of Hib meningitis had not been vaccinated for Hib. There has been no Hib meningitis cases since 2001. Overall fatality rate was 4.5%, and complication occurred in 39%. Complications was significantly less frequent in patients resumed to be treated within 48 hours after onset compared to after 48 hours after onset. Penicillin resistance of S. pneumoniae and GBS isolated among bacterial meningitis cases was high. Conclusion : Timing of treatment after the onset of the disease appeared the most important factor for prognosis of bacterial meningitis. The cases of H. influenzae meningitis have decreased probably due to Hib vaccination.

• Journal of Chest Surgery
• /
• v.38 no.5 s.250
• /
• pp.357-365
• /
• 2005

Background: Patients with mitral regurgitation (MR) in the setting of coronary artery disease have a dismal long-term prognosis whether treated medically or surgically. Moreover, the optimal management of moderate ischemic MR at the time of coronary artery bypass grafting (CABG) remains the subjects of controversy. Thus, the present retrospective study was undertaken to determine whether mitral valve surgery for moderate ischemic MR at the time of CABG would be preferable to CABG alone in terms of clinical outcome. Material and Method: Between January 1997 and December 2003, 34 patients with moderate (Gr 3/4) ischemic MR underwent CABG alone (Group I, n=23) or CABG plus mitral valve surgery (Group II, n=11). Operative mortality, long-term survival and echocardiographic parameters were used to evaluate the efficacy of mitral valve surgery in patients with moderate ischemic MR. The mean follow-up durations of each group were $69.3\pm4.3$ months and $53.1\pm4.9$ months respectively. Result: There was no hospital mortality in both groups. There was one case of late mortality in Group I. The mean number of bypass graft was similar ($3.8\pm1.2\;vs\;3.7\pm1.3$ respectively). Cardiopulmonary bypass time was longer in group II (p=0.014). In group II, all of the patients received mitral annuloplasty using ring. On immediate postoperative echo-cardiogram, mitral regurgitation was reduced more in group II (p=0.002). Echocardiogram performed at last follow-up state showed no difference except the grade of MR between the two groups. Actuarial survival of both groups at 5 years was similar ($95.5\%\;vs\;100\%$, p=0.48). Conclusion: This study shows that in selected patients with moderate ischemic MR, CABG without mitral valve surgery might be sufficient. However, patients with low EF and NYHA functional class pre-operatively had tendency of significant residual MR, so mitral valve surgery should be necessary in these patients, and moreover, MR severity and left ventricle volume decreased more in mitral valve surgery group. Therefore, more large-scale studies are necessary to determine these effects on the ventricular function and long-term survival.

• Journal of Chest Surgery
• /
• v.35 no.5
• /
• pp.369-374
• /
• 2002

Background: Proper construction of vascular access and adequate maintenance are essential for the prognosis of the hemodialysis patients. Though arteriovenous fistula using autogenous vessel is the first of choice, the incidence of arteriovenous fistula using artificial graft is gradually increasing. The aim of this study was to analyse the patency rates between autogenous and artificial fistula, among artificial graft types, according to the accompanied disease. Material and Method: A retrospective study was conducted on 186 patients who underwent 292 arteriovenous fistula operations for hemodialysis at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 54.37 $\pm$ 12.79years, and the male: female ratio 99:87. Result: Among 292 operations, there were 156 autogenous fistula and 116 graft fistula. The other 20 operations were thrombectomy, takedown of graft, revision, and balloon dilatation. Patency rates of autogenous fistula were 92.78 $\pm$ 2.35% at 1 year and 39.03$\pm$9.08% at 5 years, and those of graft fistula were 96.09 $\pm$ 2.22% at 1 year and 16.45 $\pm$ 10.15% at 5 scars. However, there was no statistical significance between the two operations. The patients who had hypertension, diabetes or both had no statistical significance in the patency rate compared to that of patients without underlying disease. In addition, the type of graft used did not affect the patency rate. Second operation was needed in 62 patients and third operation in 31 patients, but their patency rate again had no statistical significance compared to that of the first operation. Conclusion: The patency of the artificial graft fistula was comparable to the autogenous fistula, but the patency according to types of graft need to be studied further. Furthermore, the underlying diseases did not affect the fistula patency.

• Journal of Chest Surgery
• /
• v.43 no.3
• /
• pp.246-253
• /
• 2010

Background: Our objective was to review the long-term prognosis of patients with preoperative mild to moderate ischemic mitral regurgitation who underwent off-pump coronary artery bypass grafting. Material and Method: We prospectively followed 1,000 consecutive and systematic off-pump coronary artery bypass grafting patients who were operated on between September 1996 and March 2004; follow-up was achieved for 97%. Sixty-seven patients (6.7%) had mild to moderate ischemic mitral regurgitation at the time of surgery. Operative mortality, actuarial survival and major adverse cardiac event free survival were compared to assess the effect of ischemic mitral regurgitation. Result: Average follow-up was $66{\pm}22$ months. Patients with ischemic mitral regurgitation were older (p<0.001), had lower ejection fractions (p<0.001) and more comorbidities. Significantly more female patients presented with ischemic mitral regurgitation (p=0.002). There was no significant difference in operative mortality and perioperative myocardial infarction in ischemic mitral regurgitation patients (p=0.25). Eight-year survival was decreased in ischemic mitral regurgitation patients ($39.6{\pm}11.8%$ vs $76.7{\pm}2.2$, p<0.001). However, after correcting for risk factors, mild to moderate ischemic mitral regurgitation was not found to be a significant independent risk factor for long-term mortality (p=0.42). Major adverse cardiac event free survival at 8 years was significantly lower in ischemic mitral regurgitation patients ($53.12{\pm}12%$ vs $77{\pm}2%$, p<0.001). After correction for risk factors, ischemic mitral regurgitation remained a significant independent cause of major adverse cardiac events (HR: 2.31), especially congestive heart failure and recurrent myocardial infarction. Conclusion: In our series, patients with preoperative mild to moderate ischemic mitral regurgitation had a higher prevalence of preoperative risk factors than patients without ischemic mitral regurgitation. They had comparable perioperative mortality and morbidity, but, in the long term, were found to be at elevated risk for recurrent cardiac events.