• Journal of the Korean Dietetic Association
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• v.17 no.2
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• pp.176-189
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• 2011

The purpose of this study was to investigate the status of clinical nutrition services at various medical centers in Seoul, Korea. A questionnaire was distributed to the departments of nutrition at 44 hospitals in Seoul on July 2009. Nutritional screening carried out at a rate of 59.1% at the medical centers, and a significant difference was found according to the type of center, from 100% in tertiary hospitals to 18.8% in normal hospitals. On annual average, the numbers of inpatients, inpatients for malnutritional screening, inpatients with malnutrition, and inpatients for malnutrition management were 15,169.5, 10,870.9, 2,224.8, and 1,546.2, respectively. On average the group nutrition education was done 36.1 times/year for diabetes, 8.2 times/year for cancer, and 1.9 times/year for renal disease, and the numbers of participants 423.1, 95.1, and 31.5, respectively. On average the individual nutrition education of inpatients with diabetes was done 135.4 times/year for ordered-type, and 119.3 times/year for unordered-type, 106.2 times/year for paid-type, and 148.5 times/year for unpaid-type. The mean fee for education and counseling was the highest for peritoneal dialysis (73,090.9 won) but the lowest for heart disease (23,609.1 won). On average the individual nutrition education of outpatients with diabetes was done 234.6 times/year for ordered-type, and 2.5 times/year for unordered-type, 204.4 times/year for paid-type, and 32.7 times/year for unpaid-type. The mean fee for education and counseling was also the highest for peritoneal dialysis (63,500.0 won) but the lowest for heart disease (21,336.4 won). To implement more effective clinical nutrition service, a national medical insurance imbursement policy should be urgently instituted such that diseases left as unpaid are covered by health insurance, including all nutrition-related disease.

• Childhood Kidney Diseases
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• v.6 no.2
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• pp.218-226
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• 2002

Purpose: The purpose of this study is to assess the ability of power Doppler sonography in the detection of acute pyelonephritis. Materials and Methods: We performed gray scale sonography, power Doppler sonography, and $^{Tc-99m}DMSA$ scintigraphy of the kidney in 80 patients with symptoms suggesting upper urinary tract infection. All imaging studies were obtained within 4 days. On $^{Tc-99m}DMSA$ scintigraphy, decreased radioactivity or photopenic lesions were considered indicative of acute pyelonephritis. Triangular areas of decreased perfusion identified on power Doppler sonography were considered as parenchymal lesions of acute pyelonephritis. The results of gray scale sonography and power Doppler sonography were retrospectively analysed and compared with those of $^{Tc-99m}DMSA$ scintigraphy which was given as the standards of reference. Results: For 40(85%) of the 47 patients with scintigraphy-proven acute pyelonephritis, power Doppler sonography diagnosed this condition on the correct side. The acute pyelonephritis which was not revealed by power Doppler sonography was observed in seven patients. Also, in three patients, false-positive indication of pyelonephritis was given by power Doppler sonography. Gray scale sonography showed positive findings in 23(49%) of 47 patients with positive findings on scintigraphy. Conclusion: Power Doppler sonography seems to be less sensitive than $^{Tc-99m}DMSA$ DMSA scintigraphy but significantly more sensitive than gray scale sonography for the detection of acute pyelonephritis in children. Power Doppler sonography shows promise as a noninvasive means of assessing renal cortical perfusion in children with clinically suspected acute pyelonephritis.

• Childhood Kidney Diseases
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• v.3 no.1
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• pp.42-47
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• 1999

Angiotensin-converting enzyme inhibitors lower urinary protein excretion in hypertensive and normotensive patients with renal disease. Most children with nephrotic syndrome have minimal change histology and the great majority of these patients respond to the treatment with oral prednisone. Here we have studied the effects of combination of Inhibace and oral prednisone in pediatric patients with nephrotic syndrome. 45 patients with nephrotic syndrome were selected. Of these, 29 patients were treated with prednisone(2mg/kg/day) and 16 children were treated with prednisone and Inhibace(2.5mg/day). Urinary protein, blood pressure, creatinine clearance, serum creatinine, serum albumin and serum cholesterol were measured in both control and Inhibace group. Also the duration to remission after treatment was compared in both groups. The amounts of proteinuria before and after treatment were not significantly different in both group. The duration to remission of proteinuria was significantly shorter in Inhibace group compared to that in control group. The changes of blood pressure and creatinine clearance were not significant in Inhibace group. In conclusion, the combination therapy of oral prednisone and ACE inhibitor have shortened the duration to remission of proteinuria in nephrotic syndrome of children.

• Childhood Kidney Diseases
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• v.2 no.2
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• pp.178-182
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• 1998

Purpose : The conventional Whitaker test assesses the renal pelvic pressure response to a constant infusion rate of 10 mL/min in adult and 5 mL/min in children. We evaluated whether the infusion rate,5 mL/min is appropriate during Whitaker test in children. Materials and Methods : The study included 3 children with unilateral hydronephrosis, whose diuretic renography results were equivocal to define the presence of urinary obstruction. The kidneys were perfused at increasing flow rates from lmL/min. Results : There were intrapelvic pressure increases $26\;cmH_2O$ at 3 mL/min, $50\;cmH_2O$ at 2 mL/min and $80\;cmH_2O$ at 3 mL/min infusion rate, respectively. There was no need to increase the infusion rate over 4 mL/min to get a positive Whitaker test. Conclusion : Our experience with Whitaker test at variable low flow rates (1-5 mL/min) confirmed its usefulness in differentiating obstructive from nonobstructive uropathy. We recommend the increasing infusion rate from 1 mL/min during Whitaker test in children.

• Childhood Kidney Diseases
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• v.11 no.1
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• pp.106-111
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• 2007

[ $Henoch-Sch\ddot{o}nlein$ ] Purpura(HSP) is a form of vasculitis that typically affects small arteries in the skin, joints, intestinal tract and kidneys. It usually resolves spontaneously but sometimes can cause serious problems in the kidneys and intestinal tract. A 6-year-old girl with purpura, arthralgia and abdominal pain for 2 weeks was admitted. She also showed gross hematuria, generalized edema and decreased urine output. Blood pressure was in the upper normal range. Initial laboratory findings showed hypoalbuminemia, hyperlipidemia, microhematuria and nephrotic-range proteinuria(27.2 g/day). Initially, she was treated with pulse methylprednisolone, azathioprine, albumin and furosemide. Her renal biopsy revealed diffuse mesangial proliferation with strong IgA deposition. There were no crescents. On the third hospital day, she complained of severe abdominal pain and free peritoneal air was seen on abdominal X-ray. Primary repair of small bowel was performed and two pin-point sized holes were found. One week later, she still showed heavy proteinuria. Therefore, we added an ACE inhibitor and dipyridamole, and changed azathioprine to cyclosporine. One month later, the urine protein/creatinine ratio was decreased to 17.8 from 57, but heavy proteinuria has been still persisted. Here we report a rare case of a patient with HSP who had both severe nephrritc-nephrotic syndrome and small bowel perforation.

• The Journal of Internal Korean Medicine
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• v.31 no.1
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• pp.153-165
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• 2010

Objectives : The aims of this study were to investigate the cytoprotective, antioxidative and inflammation genes inhibitory effects of Patriniae Radix on the mouse LLC-$PK_1$ cells (renal epithelial cells). Methods : The cytoprotective effect of Patriniae Radix was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The antioxidative effect was measured in terms of generation amount of superoxide anion radical (${\cdot}{O_2}^-$) by 2',7'-dichlorodihydrofluorescein diacetate (DCFDA), nitric oxide (NO) by 4,5-diaminofluorescein (DAF-2), peroxynitrite ($ONOO^-$) by dihyldrorhodamine 123 (DHR 123) and prostaglandin $E_2$ ($PGE_2$) by $PGE_2$ immunoassay on $H_2O_2$-treated LLC-$PK_1$ cells. For measuring of inflammation genes inhibitory effects, western blot was performed to detect IKK-$\alpha$, phospho-$I{\kappa}B-\alpha$, NF-${\kappa}B$ (p50, p65), COX-2, iNOS, IL-$1{\beta}$ and VCAM-1 protein level in cytosol fractions from LLC-$PK_1$ cells. Results : Patriniae Radix extract reduced the $H_2O_2$-induced cell death and inhibited the amount of $H_2O_2$-induced ${\cdot}{O_2}^-$, NO, $ONOO^-$, $PGE_2$ generation dose-dependently on the mouse LLC-$PK_1$ cells in vitro. Also Patriniae Radix extract inhibited the expression of IKK-$\alpha$, phospho-$I{\kappa}B-\alpha$, COX-2, iNOS, IL-$1\beta$ and VCAM-1 genes dose-dependently by means of decreasing activation of NF-${\kappa}B$. Conclusions : According to above results, it was identified that Patriniae Radix had the cytoprotective, antioxidative and inflammation genes inhibitory effects. So it was suggested that Patriniae Radix would be effective to the treatment for the inflammatory process and inflammation-related diseases.

• Pediatric Infection and Vaccine
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• v.21 no.2
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• pp.104-113
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• 2014

Purpose: We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. Methods: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. Results: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P =0.001) and eschar (P =0.004) were more common in children, while myalgia was more common in adults. Children had a high prevalence of anemia (P =0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P <0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. Conclusion: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.

• Childhood Kidney Diseases
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• v.1 no.2
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• pp.123-129
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• 1997

Purpose : The Childhood Steroid Resistant Nephrotic Syndrome (SRNS) has a poor prognosis and there has been no effective therapy against SRNS of children. In 1990, Mendoza have reported that methylprednisolone pulse therapy was effective against SRNS of children. But in 1992, Waldo have reported that methylprednisolone pulse therapy was not as effective as in the report of Mendoza. So, retrospectively, we have studied 20 korean children with SRNS to evaluate the effect of methylprednisolone pulse therapy, Methods : Mothylprednisolone pulse therapy were given to 20 korean children with SRNS who admitted to Seoul National University Hospital from 1990 to 1995 and follow up was done Results : 1) During methylprednisolone pulse therapy, remission of nephrotic syndrome was induced in 45% of patients. 2) during follow up after the end of methylprednisolone pulse therapy, remission of nephrotic syndrome was maintained in 45% of patients. 3) 25% of patients has progressed to chronic renal failure. Conclusion : We think that the methylprednisolone pulse therapy is a effective therapy against SRNS of children with the 45%, remission rate of of SRNS in Korean Children

• Childhood Kidney Diseases
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• v.18 no.2
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• pp.128-131
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• 2014

Histopathologic evidence of "full-house" immune complex deposits is a pathognomonic feature of lupus nephritis. This report presents the case of a 12-year-old boy with persistent microscopic hematuria and proteinuria. He was diagnosed with "full-house" nephropathy based on a renal biopsy. However, there was no other clinical or biological evidence of systemic lupus erythematosus (SLE). Although the potential for isolated "full-house" nephropathy preceding SLE is unclear, such patients should be followed for clinical signs and autoantibodies of SLE. In most cases, microscopic hematuria has a good prognosis, and follow-up usually requires only regular urinalysis. However, we should be aware of isolated "full-house" nephropathy that remains asymptomatic for a long time, as few patients with no clinical signs and negative serology ultimately develop SLE.

• Journal of Chest Surgery
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• v.26 no.6
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• pp.475-482
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• 1993

90 patients[75 men and 15 women] with the thoracic disease underwent video-assisted thoracic surgery[VATS] during the period March 1992 to February 1993. The thoracic diseases were classified into two groups of spontaneous pneumothorax and general thoracic patients and they were 66 and 24, respectively.The mean size of the tumor resected was 4.3 $\pm$ 2.0 cm x 3.3 $\pm$ 1.1 cm x 2.7 $\pm$ 1.0 cm. The mean time of anesthesia and operation were 90.0 $\pm$ 19.9 min and 43.7 $\pm$ 13.1 min in spontaneous pneumothorax group and 123.3 $\pm$ 40.3 min and 62.8 $\pm$ 32.2 min in general thoracic group. The mean period of postoperative chest tube drainage and hospital stay were 5.0$\pm$ 5.5 days and 6.6 $\pm$ 7.4 days in spontaneous pneumothorax group and 3.5$\pm$ 1.6 days and 9.5 $\pm$ 6.1 days in general thoracic group. The indications of VATS were 71 pleural disease[78.9%: 66 spontaneous pneumothorax; 3 pleural effusions ; 1 pleural paragonimus westermanii cyst; 1 malignant pleural tumor with metastasis to the lung], 9 mediastinal disease[10.0%: 5 benign neurogenic tumor; 2 pericardial cyst; 1 benign cystic teratoma; 1 undifferentiated carcinoma], 8 pulmonary parenchymal disease[8.9%: 3 infectious disease ; 3 interstitial disease ; 2 malignant tumor ], and 2 traumatic cases of exploration and removal of hematoma[2.2%]. The applicated objectives of VATS were diagnostic[ 7 ], therapeutic[ 67 ] and both[ 16 ] and the performed procedures were pleurodesis[ 66 ], wedge resection of lung[ 59 ], parietal pleurectomy[ 11 ], removal of benign tumor[ 9 ], excision and/or biopsy of tumor[ 4 ], pleural biopsy and aspiration of pleural fluid[ 3 ] and exploration of hemothorax and removal of hematoma in traumatic 2 patients. The complication rate was 24.2%[ 16/66 ] in the spontaneous pneumothorax group and 8.3%[ 2/24 ] in the general thoracic group and so overally 20.0%[ 18/90 ]. The mortality within postoperative 30 days was 2.2%[ 2/90 ], including 1 acute renal failure and 1 respiratory failure due to rapid progression of pneumonia. The conversion rate to open thoracotomy during VATS was 5.6%[ 5/90 ], including 2 immediate postoperative massive air leakage, 1 giant bullae, 1 malignant pleural tumor with metastasis to lung and 1 pulmonary malignancy. The successful cure rate of VATS was 75.8%[ 50/66 ] in the spontaneous pneumothorax group and 76.5%[ 13/17 ] in the general thoracic group and the successful diagnostic rate was 100%[ 7/7 ]. In conclusion, although prospective trials should be progressed to define the precise role of VATS, the VATS carries a low morbidity and mortality and high diagnostic and therapeutic success rate and now can be effectively applicated to the surgical treatment of the extensive thoracic disease.