• Pediatric Infection and Vaccine
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• v.23 no.2
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• pp.128-136
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• 2016

Purpose: This study was done to define clinical characteristics of fever without localizing signs (FWLS) in infants younger than 100 days of age with a goal of providing baseline data to establish a new diagnostic paradigm in the future. Methods: We reviewed medical records of 183 patients who admitted to Daegu Catholic University Medical Center for FWLS younger than 100 days of age from January 2013 to September 2015 retrospectively. Demographic, clinical features and laboratory findings were analyzed. Patients were divided into serious bacterial infection (SBI) and non-SBI groups, and then were compared between two groups to find risk factors for SBI. Results: Among 183 patients, lumbar puncture was performed in 98.9% and CSF pleocytosis was present in 35.9%. Sterile CSF pleocytosis was found in 43% of urinary tract infection (UTI) patients. None had concomitant bacterial meningitis in patients with UTI. As final diagnosis, febrile syndrome without source (25.7%) was most common. Among SBI, UTI was most common (99%). Birth weight, ESR, and CRP were significantly higher in SBI group compared to non-SBI group. Male sex (OR 4.93, 95% CI 1.60-15.24) and pyuria (OR 18.88, 95% CI 6.76-52.76) were identified as risk factors for SBI. Presence of sibling (OR 0.30, 95% CI 0.11-0.83) was significantly lower in SBI group. Conclusions: Our results showed UTI was the most common SBI in young infants with FWLS. Though aseptic meningitis can be coexisting with UTI, lumbar puncture may not be necessary in all patients having UTI.

• Pediatric Infection and Vaccine
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• v.23 no.1
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• pp.31-39
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• 2016

Purpose: The aim of this study was to investigate the prognostic factors for Pneumocystis jirovecii pneumonia (PCP) and to evaluate the influence of PCP prophylaxis in pediatric patients. Methods: From January 2002 to April 2015, patients aged <18 years with a diagnosis of confirmed PCP at our institute were reviewed retrospectively. Clinical characteristics and outcomes were compared according to the groups with or without PCP prophylaxis. Risk factors associated with PCP-related death were analyzed by logistic regression analysis. Results: During study period, a total of 24 patients were diagnosed with PCP by immunofluorescence assay and/or PCR. The median age of the patients was 5 years (range, 3 months-18 years) and 23 (96%) had immunocompromised conditions including hematologic disorders with or without hematopoietic stem cell transplantation (n=15), solid organ transplantation (n=4), and primary immune deficiency (n=4). Most common presenting symptoms were tachypnea and cough (92%, each). At the time of diagnosis, 79% (19/24) and 25% (6/24) suffered from respiratory failure and multi-organ dysfunction syndrome (MODS), respectively. Mechanical ventilation was required in 8 (33%) patients and 5 (21%) patients died of PCP. Multivariate analysis showed that MODS at initial presentation was an indicator of poor prognosis (OR, 17.1 [95% CI 1.13-257.67]; P=0.04). Compared to the patients without PCP prophylaxis, the frequency of MODS at diagnosis, need for mechanical ventilation and length of hospital days were significantly less common in the children who received PCP prophylaxis. Conclusions: MODS at presentation was a significant predictor for poor outcome and PCP prophylaxis could alleviate the clinical courses of pediatric PCP. Prospective study will be mandatory to determine the risk factors for development and deterioration of PCP in children.

• Korean Security Journal
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• no.35
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• pp.125-149
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• 2013

In this study changes in biorhythm are observed by measuring heart rate variabilities in order to verify, compare, and evaluate stresses in guard duties of guards and CCTV monitoring works of staffs serviced in practical guard sites. Guard duties and CCTV monitoring works similar to a practical situation are implemented for nine students in the department of security at K University over 150 minutes. In the results of observing heart rate variabilities and autonomic function tests for six times with an interval of 30 minutes, the heart rate variability (HRV) in CCTV monitoring works represents lower levels than that of guard duties. Also, in a stable condition the guard duties for 30 and 60 minutes exhibit lower levels than that of 90, 120, and 150 minutes. Regarding SDNN, CCTV monitoring works show higher levels that guard duties and the guard duties for 30 and 60 minutes represent lower levels than that of 150 minutes. In autonomic function tests, there are no differences in TP between groups according to guard duties and CCTV monitoring works. Also, the guard duties for 150 minutes represent more differences in TP compared to that of 30 minutes. The interaction between the duty type and the duty duration is presented. In the case of LF, guard duties for 150 minutes show large differences in duty duration compared to that of 60 minutes. In the case of HF, the CCTV monitoring work group shows higher levels than the guard duty group in which the guard duties for 120 and 150 minutes represent higher levels than that of 30 minutes. The interaction between the duty type and the duty duration is presented. In the case of the LF/HF ratio, the guard duty group exhibits higher levels than the CCTV monitoring group. Also, there is an interaction between the duty type and the duty duration including the difference in durations. The CCTV monitoring works represent lower heart function activities than the guard duties according to increases in parasympathetic nervous activities. It shows that the long-term CCTV monitoring duty repeated everyday shows a high possibility of increasing the exposures of VDT syndrome and nervous breakdown.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.422-427
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• 1999

Background: Tachycardia induced heart failure model would be the model of choice for the dilated cardiomyopathy. This more closely resembles the clinical syndrome and does not require major surgical trauma, myocardial ischemia and pharmacological or toxic depression of cardiac function. When heart failure is progressive, application of new surgical procedures to the faling heart is highly risky. It has been shown that recovery trajectory from heart failure is a new method in decreasing animal mortality. The purpose is to establish the control datas for recovery trajectory in the canine heart failure model. Material and Method: 21 mongrel dogs were studied at 4 stages(baseline, at the heart failure, 4 and 8 weeks after recovery). Heart failure was induced during 4 weeks of continuous rapid pacing using a pacemaker. Eight weeks of trajectory of recovery period was allowed. Indices of left ventricular function and dimension were measured every 2 weeks and the hemodynamics were measured by use of Swan-Ganz catheterization and thermodilution method every 4 weeks. Values were expressed as mean${\pm}$standard deviation. Result: 4(20%) dogs died due to heart failure. Left ventricular end-diastolic volume at the 4 stages were 40.8${\pm}$7.4, 82.1${\pm}$21.1, 59.9${\pm}$7.7 and 46.5${\pm}$6.5ml. Left ventricular end-systolic volume showed the same trend. Ejection fractions were 50.6${\pm}$4.1, 17.5${\pm}$5.8, 36.3${\pm}$7.3, and 41.5${\pm}$2.4%. Blood pressure and heart rate showed no significant changes. Pressures of central vein, right ventricle, pulmonary artery, and pulmonary capillary wedge showed significant increase during the heart failure period, normalizing at the end of recovery period. Stroke volumes were 21.5${\pm}$8.2, 12.3${\pm}$3.5, 17.9${\pm}$4.6, and 15.5${\pm}$3.4ml. Blood norepinephrine level was 133.3${\pm}$60.0pg/dL at the baseline and 479.4${\pm}$327.3pg/dL at the heart failure stage(p=0.008). Conclusion: Development of tachycardia induced heart failure model is of high priority due to ready availability and reasonable amenability to measurements. Recovery trajectory after cessation of tachycardia showed reduction of cardiac dilatation and heart function. Application of new surgical procedures during the recovery period could decrease animal mortality.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.755-761
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• 2004

We evaluated the efficacy of Dor procedure in patients with ischemic left ventricular dysfunction. Material and Method: Between April 1998 and December 2002, 45 patients underwent the Dor procedure con-comitant with coronary artery bypass grafting (CABG). Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic/end-systolic volumes (LVEDV/LVESV) were measured by echocardiography, myocardial SPECT, and cardiac catheterization and angiography performed at the sequence of preoperative, early postoperative, and one year postoperative stage. Result: Cardiopulmonary bypass and aortic clamp times were mean 141$\pm$64, 69$\pm$24 minutes, respectively. Intraaortic balloon pump (IABP) therapy was required in 19 patients (42%; 7 preoperatively, 9 intraoperatively, 3 postoperatively). Operative mortality rate was 2.2% (1/45). Postoperative morbidities were low cardiac output syndrome (12), atrial fibrillation (5), acute renal failure (4), and postoperative bleeding (4). Functional class (NYHA) was improved from classes 2.8 to 1.1 (p < 0,01). When we compared between the preoperative and early postoperative values, LVEF was improved from 32$\pm$9% to 52$\pm$11% (p<0.01). The asynergy portion decreased from 57$\pm$12% to 22$\pm$9%, and LVEDV/LVESV indexes improved from 125$\pm$39 mL/$m^2$, 85$\pm$30 mL/$m^2$ to 66$\pm$23 mL/$m^2$, 32$\pm$16 mL/$m^2$ (p<0.01). Although these changes in volumes were relatively preserved at postoperative one year, the left ventricular volumes showed a tendency to increase. Conclusion: After the Dor procedure for ischemic left ventricular dysfunction, LVEF improvement and left ventricular volume reduction were maintained till postoperative one year. The tendency for left ventricular volume to increase at postoperative one year suggested the requirement of strict medical management.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.299-304
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• 2009

Background: Although the results of the surgical management for complete atrioventricular septal defect (c-AVSD) have improved, the optimal surgical strategy is still controversial. The aims of this study are to evaluate the outcome of c-AVSD repair and to define the risk factors related to reoperation. Material and Method: We retrospectively reviewed the medical records of 35 patients (8 males and 27 females) who underwent the total correction of c-AVSD from August 1996 to March 2008. The median age at repair was 5.2 months (range: 3 days$\sim$82 months). Sixteen patients (45.7%) were associated with Down syndrome. Prior palliative operations were performed in 4 patients. The one-patch techniques were performed in 3 patients, and the two-patch techniques were done in 32 patients. Result: There was 1 early death (2.9%). The median follow-up period was 68 months (range: $2\sim134$ months) for 34 survivors. There was no late death. Reoperations were performed in 5 patients (14.3%) for severe left atrioventricular valvular regurgitation (AVVR). Nine patients (25.7%) showed left an AVVR of more than grade III. Associated major cardiac anomalies and the use of Gore-Tex patch for ventricular septal closure were the risk factors for postoperative left atrioventricular valve failure and reoperation. Conclusion: In this study, we found that surgical repair of c-AVSD was safe and effective. However, the high reoperation rate after repair remains a problem to be solved.

• The Korean Journal of Mycology
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• v.32 no.1
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• pp.8-15
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• 2004

This study was conducted to discover new phytotoxins which may be used as lead molecules for the development of new herbicides. A total of 187 endophytic fungi were isolated from 11 plant species, which were collected from 8 locations in Korea. Their herbicidal activities were screened in vivo by herbicidal and duckweed bioassays after they were cultured in potato dextrose broth and rice solid media. Both fermentation broth and solid culture extract of Gliocladium catenulatum F0006 isolated from red pine (Pinus densiflora) showed 70% herbicidal activity only against cocklebur (Xanthium strumarium) out of the 10 weeds tested. Solid culture extract of F0034 isolated from arrowroot (Pueraria thunbergiana) exhibited 20 to 100% herbicidal activities against all of the weeds. Especially, shattercane (Sorghum bicolor), barnyardgrass (Echinochloa crus-galli), large crabgrass (Digitaria sanguinalis), and fall pauicum (Panicum dichtomiflorum) were sensitive to the solid culture extract of F0034. In addition, solid culture extract of F0043 isolated from red pine displayed 20% to 70% herbicidal activities only against 5 grass species, but not against 5 broad-leaf plant species. On the other hand, as the results of duckweed assay, 8 fermentation broths showed 100% growth inhibitory activity at concentrations less than 5.0% of culture supernatants and 12 solid cultures had a potent inhibitory activity against duckweed growth. A toxic metabolite was purified from the solid cultures of G. catenulatum F0006 by repeated column chromatography and bioassay. It caused a phytotoxic syndrome only on cocklebur out of the 10 weeds tested; it completely killed cocklebur seedlings at $500\;{\mu}g/ml$ and showed 85% herbicidal activity against cocklebur at $100\;{\mu}g/ml$. The molecular weight of the toxic metabolite is 238 daltons and its structure determination is underway.

• The Journal of Internal Korean Medicine
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• v.31 no.4
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• pp.792-812
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• 2010

In the 18th century, Xu Lingtai (徐靈胎) and Yoshimasu Todo (吉益東洞) were famous doctors advocating ancient medicine, though they lived in different countries, China and Japan. We compared their major books, analyzed their academic thoughts and then took conclusions as below. 1. The first, for instance "Classified Prescriptions of Treatise on Cold Damage Diseases, 傷寒論類方" and "Classified Assemblage of Prescriptions, 類聚方". Based on essential thought that a prescription and a syndrome should correspond, these books arranged and classified the Zhang Zhongjing (張仲景)'s texts."Classified Prescriptions of Treatise on Cold Damage Diseases", based on the thought that principles, methods, formulas and medicinals (理法方藥) were integrated in prescriptions, tried to find out the implicit treatment rules in prescriptions and syndromes through analyzing "Treatise on Cold Damage Diseases, 傷寒論". On the other hand, because Classified Assemblage of Prescriptions focused on the syndromes of ancient prescriptions (古方), it classified and collected the related texts of Treatise on Cold Damage Diseases and "Synopsis of Prescriptions of the Golden Chamber, 금궤요략", and then suggested only simple instructions on how to prescribe medicine. So in this book, the trend of experience was clear. 2. The second, there is "100 Kinds Records from Shennong's Classic of Materia Medica, 神農本草經百種錄" and "Description work of herbal pharmacology comprised of excerpts from Shanhanlun and medical experiences, 藥徵". Though both of these books are professional oriental pharmacology publications that advocate reactionism, there were remarkable differences in writing style between them. "Description work of herbal pharmacology comprised of excerpts from Shanhanlun and medical experiences" was based on "Treat on Cold Damage Diseases" and "Synopsis of Prescriptions of the Golden Chamber", just explained the effects of medications and discussed 'matter of course (所當然)', but not discussed 'the reason why (所以然)'. In explaining style of syndromes, it confirmed through research, and emphasized the inductive method. On the other hand, "100 Kinds Records from Shennong's Classic of Materia Medica based on "Shennong's Classic of Materia Medica, 神農本草經", explained the nature of medications and discussed 'the reason why (所以然)'. In explaining style of syndromes, it annotated and explained, and emphasized the process of reasoning. 3. The third, there is "Discuss the Headwaters of Medicine, 醫學源流論" and Severance of Medical evils, 醫斷". Aiming the then medical theories fallen in confused state, these books brought order out of chaos, clarified the categories of medical research, and emphasized the scientific method that could put theories into practice and verify them. The difference is that "Severance of Medical Evils" researched only macroscopic viewable clinical phenomena, and even denied the existence of names of diseases and etiological causes. Thus, it emphasized the accumulation of experiences, laid emphasis on "watching and realizing (目認)", and "understand and taking in (解悟)". Discuss the Headwaters of Medicine extremely emphasized the research of 'something not occuring (未然)', that is to say, induced notions of a disease from observing clinical phenomena, furthermore based on these, predicted the 'something not occuring (未然)' and emphasized researching 'the reason why (所以然)'. As regards how they deal with the traditional theories and post-Zhang Zhongjing's medicines, "Severance of Medical evils" took completely denying attitudes. In case of "Discuss the Headwaters of Medicine", it could be used reasonably through specific situation and detailed analysis. Collectively speaking, there were some differences between medical theories of Xu Lingtai and Yoshimasu Todo. Actually, these differences were whether he tried to research the essence of disease, whether he tried to consider it rationally, and how he treated various opinions occurring in the theories of traditional medicine and clinical experience.

• Journal of Chest Surgery
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• v.38 no.3 s.248
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• pp.204-213
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• 2005

In spite of the improvement in the quality of artificial heart valves and surgical techniques, the incidence of the complications following valve replacement is still high. We reviewed the clinical results of the valve replacements peformed in Korean University Anam Hospital during the last 26 years. Material and Method: The data of 571 patients who received valve replacement between December 1976 and December 2003 were reviewed. Result: There were 304 cases of MVR which was the most common procedure performed. There were 122 cases of AVR, and 111 cases of AVR with MVR. Among the 47 patients who received redo operation 38 cases were redo cases including 31 cases of MVR. $32.5\%$ of the patients who had tissue valve replacement had second valve replacement with 10.2 $\pm$ 3.9 years interval. $24.3\%$ (139/571) of the patients developed valve related complications and cerebral infarction was the highest in frequency. Atrial fibrillation was related with increased complication rates and the mechanical valve replaced group had higher hemorrhagic complication rate than tissue valve replaced group. The operative mortality was $3.68\%$ and the most common cause of the failure was low output syndrome. The operative mortality was higher in the patient group who had valve replacement before the year 1990. The patient group who had mechanical valve replacement had higher operative mortality rate th;3n the tissue valve group. The 5-year survival rate was $92.2\%$ and 10 year survival rate was $85.7\%$. Conclusion: The operative mortality of valve replacement has been improved. The mechnical valve replaced patients had higher hemorrhagic complication rate than the tissue valve replaced patients and more tissue valve replaced patients received redo valve replacement.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.875-882
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• 1996

Multlvalvular heart surgery was performed In 78 cases, in the Department of Thoracic & Cardiovascu far Surgery of Chonbuk national University Hospital from november 1983 to March 1994. There Where 31 men and 47 women. whose ranged from 14 to 63 years. The causes of the valvular lesions were 57 rheumatic origin, 18 degenerative, 1 previous endocarditls, 1 prosthetic valve mal-function. There were 25 double valve replacement with or wit out tricuspid valve repair, i M VR and aortic valve repair, 18 MVR and tricuspid valve repair, 1 MVR and aortic and tricuspid valve repair, 10 AVR and mi- tral valve repair, 1 AVR and tricuspid valve repair, 8 mitral aortic valve repair, 13 mitral and tricuspid valve repair. They were improved mean New York Heart Association functional cldss, from 2.72% 121 Early deaths were 5 cases(6.4%). The cause of death wet'e low cArdiac output syndrome. veritricular tachycardia, massive bleeding and cerebral thromboembolism. All the survivors belonged to New York Heart Association functional class I or ll at discharge. The patients who had had valve replacement operation were medicated with warfarin to maintain the level of 30∼ 50% of normal prothrombin time. During follow-up(93.6%, mean 49.9 months), 2 late deaths were developed. One was due to intracranial hemorrhage and the other congestive heart failure. The pre-operative New York Heart Association Functional class IV was statistically sig ificant operat- ive risk factors(p< 0.05).