• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권6호
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• pp.510-517
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• 2021

Purpose: Consensus is lacking regarding the optimal antibiotic treatment for pediatric complicated appendicitis. This study determined the optimal first-line antibiotic treatment for pediatric patients with complicated appendicitis based on peritoneal fluid cultures. Methods: This retrospective study examined the cases of pediatric patients who underwent appendectomy for complicated appendicitis at our institution between 2013 and 2019. Peritoneal fluid specimens obtained during appendectomy were cultured for the presence of bacteria. Results: Eighty-six pediatric patients were diagnosed with complicated appendicitis. Of them, bacteria were identified in 54 peritoneal fluid samples. The major identified bacteria were Escherichia coli (n=36 [66.7%]), Bacteroides fragilis (n=28 [51.9%]), α-Streptococcus (n=25 [46.3%]), Pseudomonas aeruginosa (n=10 [18.5%]), Enterococcus avium (n=9 [16.7%]), γ-Streptococcus (n=9 [16.7%]), and Klebsiella oxytoca (n=6 [11.1%]). An antibiotic susceptibility analysis showed E. coli was inhibited by sulbactam/ampicillin in 43.8% of cases versus cefmetazole in 100% of cases. Tazobactam/piperacillin and meropenem inhibited the growth of 96.9-100% of the major identified bacteria. E. coli (100% vs. 84.6%) and P. aeruginosa (100% vs. 80.0%) were more susceptible to amikacin than gentamicin. Conclusion: Tazobactam/piperacillin or meropenem is a reasonable first-line antibiotic treatment for pediatric complicated appendicitis. In the case of aminoglycoside use, amikacin is recommended.

• Korean Journal of Radiology
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• 제22권1호
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• pp.63-71
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• 2021

Objective: To identify the CT findings associated with treatment failure after antibiotic therapy for acute appendicitis. Materials and Methods: Altogether, 198 patients who received antibiotic therapy for appendicitis were identified by searching the hospital's surgery database. Selection criteria for antibiotic therapy were uncomplicated appendicitis with an appendiceal diameter equal to or less than 11 mm. The 86 patients included in the study were divided into a treatment success group and a treatment failure group. Treatment failure was defined as a resistance to antibiotic therapy or recurrent appendicitis during a 1-year follow-up period. Two radiologists independently evaluated the following CT findings: appendix-location, involved extent, maximal diameter, thickness, wall enhancement, focal wall defect, periappendiceal fat infiltration, and so on. For the quantitative analysis, two readers independently measured the CT values at the least attenuated wall of the appendix by drawing a round region of interest on the enhanced CT (HU_post) and non-enhanced CT (HU_pre). The degree of appendiceal wall enhancement (HU_sub) was calculated as the subtracted value between HU_post and HU_pre. A logistic regression analysis was used to identify the CT findings associated with treatment failure. Results: Sixty-four of 86 (74.4%) patients were successfully treated with antibiotic therapy, with treatment failure occurring in the remaining 22 (25.5%). The treatment failure group showed a higher frequency of hypoenhancement of the appendiceal wall than the success group (31.8% vs. 7.8%; p = 0.005). Upon quantitative analysis, both HU_post (46.7 ± 21.3 HU vs. 58.9 ± 22.0 HU; p = 0.027) and HU_sub (26.9 ± 17.3 HU vs. 35.4 ± 16.6 HU; p = 0.042) values were significantly lower in the treatment failure group than in the success group. Conclusion: Hypoenhancement of the appendiceal wall was significantly associated with treatment failure after antibiotic therapy for acute appendicitis.

• 대한영상의학회지
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• 제82권1호
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• pp.182-193
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• 2021

목적 애매한 초음파 결과를 보인 소아 환자들에서 충수돌기염을 감별하는 데 도움이 되는 초음파 소견들을 알아보고자 한다. 대상과 방법 2012년 11월부터 2017년 10월 사이에 충수돌기염이 의심되어 초음파를 시행한 소아 환자 중 애매한 결과를 보인 53명의 환자를 대상으로 하였다. 초음파 검사는 정해진 구조화 판독문을 사용했으며 충수돌기염의 가능성은 5가지로 분류되었다. 그중 3등급과 4등급을 애매한 결과로 간주하였다. 결과 53명의 환자 중 각각 25명(47.2%)과 28명(52.8%)이 3등급과 4등급으로 분류되었다. 각 초음파 소견 중 충수돌기 벽의 혈류 증가와 충수돌기 주변의 지방 침윤이 충수돌기염을 진단하는 데 다변량 로지스틱 회귀분석에서 의미 있는 소견이었고(p = 0.005, p = 0.045), 진단적 정확도도 높았다(69.8%, 62.3%). 결론 충수돌기 벽의 혈류 증가와 충수돌기 주변의 지방 침윤은 애매한 초음파 결과를 보인 소아 환자들에서 의미 있는 충수돌기염의 예견 인자이다.

• 한국임상약학회지
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• 제5권2호
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• pp.1-12
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• 1995

The purpose of this investigation was to determine pharmacokinetic parameters of gentamicin using linear least square regression(LLSR) and Bayesian analysis in Korean normal volunteers and appendicitis patients. Nonparametric expected maximum(NPEM) algorithm for population pharmacokinetic parameters was used. Gentamicin was administered every 8 hours for 3 days by infusion over 30 minutes. The volume of distribution(V) and elimination rate constant(K) of gentamicin were $0.215\pm0.0562,\;0.226\pm0.0325L/kg\;and\;0.339\pm0.0443,\;0.357\pm0.0243hr^{-1}$ for normal volunteers and appendicitis patients using LLSR analysis. Population pharmacokinetic parameters, VS and KS were $0.228\pm0.0614L/kg\;and\;0.00356\pm0.00041(hr{\cdot}mL/min/1.73m^2)^{-1}$ for appendicitis patients using NPEM algorithm. The V and K were $0.232\pm0.0568L/kg\;and\;0.337\pm0.0385hr^{-1}$ for appendicitis patients using Bayesian analysis. There were no differences in gentamicin pharmacokinetics between LLSR and Bayesian analysis.

• Advances in pediatric surgery
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• 제10권2호
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• pp.127-130
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• 2004

Appendectomy is the most common emergency surgical operation in children. The laparoscopic treatment of pediatric appendicitis is controversial, particularly in complicated cases. The purpose of this study is to evaluate laparoscopic appendectomy (LA) and open appendectomy (OA) for simple and perforated appendicitis (SA, PA) in children. A total of 188 patients, operated from January 1992 to September 2003, were reviewed. Ninety-one patients underwent OA (65 SA and 26 PA) and 97 had LA ( 67 SA, 30 PA). There was one conversion of LA to OA in PA. Operative time for LA was longer for OA in PA (55.8 vs. 45.7 min; p=0.0467). Recovery of bowel movement, diet starting time, length of hospital stay for LA were significantly shorter than those for OA. Postoperative complication rate was not different between LA and OA in each group. Laparoscopic appendectomy is a safe and effective method for both simple and perforated appendicitis.

• 한국정보통신학회논문지
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• 제16권11호
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• pp.2382-2387
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• 2012

본 논문에서는 충수염 영상 분석에 필요한 두께, 염증의 변화량 등의 자료를 객관적으로 측정할 수 있도록 하기 위해 복부 초음파 영상에서 충수염을 추출하고 분석하는 방법을 제안한다. 초음파 영상은 동일한 환경에서 영상을 촬영할 수 없기 때문에 객관적인 분석을 위해 초음파 영상을 표준화 한다. 본 논문에서 사용된 영상은 표준화된 초음파 영상을 대상으로 하였으며, 충수염 추출 과정은 사람마다 초음파 영상 결과가 다르게 나타나므로 최하단 근막을 추출한 뒤, 최하단 근막을 기준으로 충수염을 추출한다. 제안된 방법을 초음파 영상을 대상으로 실험한 결과, 제안된 충수염 추출 및 분석 방법이 측정자가 직접 충수염을 추출하고 분석하는 방법보다 효과적인 것을 확인할 수 있었다.

• Advances in pediatric surgery
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• 제18권2호
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• pp.83-88
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• 2012

Acute appendicitis is very rare in premature neonates. Preoperative diagnosis of this condition is difficult, and then it leads to high morbidity and mortality. We report 9-day-old premature male with ruptured acute appendicitis presented with pneumoperitoneum on plain films of the abdomen. Awareness of this rare condition and possible differential diagnosis in this age group is also discussed.

• 한국감성과학회:학술대회논문집
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• 한국감성과학회 2000년도 춘계 학술대회 및 국제 감성공학 심포지움 논문집 Proceeding of the 2000 Spring Conference of KOSES and International Sensibility Ergonomics Symposium
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• pp.253-257
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• 2000

the objective of this study is to design and evaluate a methodology for diagnosing the appendicitis in a fuzzy neural network that integrates the partition of input space by fuzzy entropy and the generation of fuzzy control rules and learning algorithm. In particular the diagnosis of appendicitis depends on the rule of thumb of the experts such that it associates with the region, the characteristics, the degree of the ache and the potential symptoms. In this scheme the basic idea is to realize the fuzzy rle base and the process of reasoning by neural network and to make the corresponding parameters of the fuzzy control rules be adapted by back propagation learning rule. To eliminate the number of the parameters of the rules, the output of the consequences of the control rules is expressed by the network's connection weights. As a result we obtain a method for reducing the system's complexities. Through computer simulations the effectiveness of the proposed strategy is verified for the diagnosis of appendicitis.

• 대한한방소아과학회지
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• 제24권3호
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• pp.43-49
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• 2010

Objectives: This study was to evaluate the effects of herbal medication and acupuncture therapy for children with acute appendicitis diagnosed by abdominal ultrasonography. Methods: Kamieuiyeeintang, a Korean Herb medicine, and acupuncture were given for four days. The abdominal ultrasonography and VAS scale were used to check the improvements. Results: Right lower abdominal pain, nausea and anorexia were totally gone after the treatments, and the abdominal ultrasonography showed normal. Conclusions: The result of this study showed that Kamieuiyeeintang medication and acupuncture treatment have cured acute appendicitis.

• Pediatric Infection and Vaccine
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• 제25권1호
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• pp.1-7
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• 2018

목적: 본 연구에서는 천공성 충수염을 예측할 수 있는 인자들을 분석하고, 원인균을 조사하고자 하였다. 방법: 2012년 1월부터 2014년 12월까지 한림대학교 성심병원에서 19세 미만에 충수염으로 수술을 진행한 569명을 대상으로 하였다. 이들의 입원 당시의 병력청취 기록과 혈액검사, 영상검사, 균 배양검사를 분석하였다. 결과: 총 569명 중 127명(22%)에서 천공이 확인되었다. 충수염의 천공 비율은 소아기, 학령기, 청소년기에서 각각 50%, 27.8%, 16.8%였다. 높은 C-반응단백질 수치, 충수대변돌 존재가 천공 충수염의 위험인자였다(P<0.001). 24명의 환자에서, 수술 중 복강 내 복막액 또는 충수 주위에 농이 관찰될 때 균 배양검사를 시행하였고, 16명(66%)에서 균이 배양되었다. 가장 많이 배양된 균은 Escherichia coli(n=10)였다. 나머지 균은 Pseudomonas aeruginosa, Streptococcus spp., Staphylococcus spp.였다. 결론: 5세 이하의 환자에서 충수염의 천공 비율은 50%였고, 천공 비율은 나이가 많을수록 낮았다. 충수염 진단 당시 C-반응단백질 수치가 높거나, 영상검사에서 충수대변돌이 관찰될 때, 천공성 충수염 가능성이 높으므로 주의해야 한다.