• Clinical and Experimental Pediatrics
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• v.60 no.3
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• pp.77-85
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• 2017

Purpose: Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories. Methods: Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ${\geq}38.0^{\circ}C$ for longer than ${\geq}14days$ and failure to reach a diagnosis after one week of investigations were included. Results: Total 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%). Conclusion: Almost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.

• Research in Community and Public Health Nursing
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• v.15 no.1
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• pp.56-66
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• 2004

Objectives: The purpose of this study was to verify a change for family nursing phenomena and satisfaction of clients of vulnerable families in an urban community. Methods: The study subjects were 711 families, randomly selected, who had chronic diseases(arthritis diabetes, stroke, hypertension, mental disease, cancer, dementia) with basic social welfare services from the nation and had disabled persons in an urban community, South Korea. The instruments used were the family nursing phenomena in Korea by ICNP and client satisfaction. Client satisfaction consisted of client satisfaction on home visiting nurses(4 Likert scales) and home visiting services(3 Likert scales). Results: The average visiting number is 3.82. The service number of education and counseling is 3.16, patient and symptom management 3.08, assessment and diagnosis 3.08, test 2.02, medication service 1.71회, dressing 1.01, referral to social welfare institute 1.00회, referral to medical service institute 0.21. In both, pre home visiting and post home visiting, the highest rated phenomenon was the 'lack of social support system' and following that 'deficit of financial management skill and support'. 'lack of family interaction in community', and 'social isolation' 'unhealthy life style' and 'inadequate care management of sick member', in that order. The percentages of phenomena besides 'deficit of financial management skill and support' decreased. The satisfaction level of clients towards the nurses was 3.27 points on a scale of 4, and the nursing services was 2.70 points on a scale of 3. Conclusion: Home visiting nursing services should continue to provide comprehensive healthcare services and support for vulnerable families, in urban communities.

• Annals of Clinical Neurophysiology
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• v.4 no.1
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• pp.34-37
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• 2002

Background : The term "mononeuropathy multiplex" means simultaneous or sequential involvement of individual noncontiguous nerve trunks, evolving over days to years. The aim of this study was to delineate the causes, clinical features, and detailed electrophysiological findings in the patients with mononeuropathy multiplex. Methods : We analyzed the medical records of 22 patients with mononeuropathy multiplex confirmed on electrophysiological studies in Inje University Seoul Paik Hospital, Seoul Municipal Boramae Hospital, and Seoul National University Hospital between 1991 to 2000. Results : The number of male and female patients was equal. The mean age was 48 years with a peak incidence in the sixth decade. The etiology could be divided into vasculitis(11 patients) or non-vasculitis group. In vasculitis group, Churg-Strauss syndrome, polyarteritis nodosa, and rheumatoid arthritis were included. The non-vasculitis group included diabetes mellitus, leprosy, and Guillain-Barre syndrome. Ulnar and median nerves were most commonly involved(91%). In descending order of frequency, peroneal, posterior tibial, sural, and radial nerves were also involved. Bilateral involvement occurred most commonly in ulnar nerve. The symptoms and signs of mononeuropathy multiplex were the initial manifestations in 12 patients(55%), which was more frequent in vasculitis group(73%). Nerve conduction abnormalities could be divided into axonal, demyelinating, or mixed type. Most(91%) of the patients in vasculitis group revealed axonal type abnormalities. The location of the nerve lesion was frequently related to potential site of entrapment in demyelinating type. Conclusions : Mononeuropathy multiplex is the presenting features of the etiological disease frequently, especially in vasculitis group. Nerve conduction studies(NCS) reveals not only axonal type but also demyelinating type abnormalities. The etiological diseases were different in each type. Therefore, NCS is very helpful for the early etiological diagnosis and therapeutic implication in the patients with mononeuropathy multiplex.

• Clinical and Experimental Pediatrics
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• v.59 no.sup1
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• pp.5-9
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• 2016

Blau syndrome (BS) is a rare autosomal dominant, inflammatory syndrome that is characterized by the clinical triad of granulomatous dermatitis, symmetric arthritis, and recurrent uveitis. Mutations in the nucleotide oligomerization domain 2 (NOD2 ) gene are responsible for causing BS. To date, up to 30 Blau-associated genetic mutations have been identified within this gene. We report a novel NOD2 genetic mutation that causes BS. A girl, aged 8 years, and her brother, aged 10 years, developed erythematous skin rashes and uveitis. The computed tomography angiogram of the younger sister showed features of midaortic dysplastic syndrome. The brother had more prominent joint involvement than the sister. Their father (38 years) was also affected by uveitis; however, only minimal skin involvement was observed in his case. The paternal aunt (39 years) and her daughter (13 years) were previously diagnosed with sarcoidosis. Mutational analysis revealed a novel c.1439 A>G mutation in the NOD2 gene in both siblings. The novel c.1439 A>G mutation in the NOD2 gene was found in a familial case of BS. Although BS is rare, it should always be considered in patients presenting with sarcoidosis-like features at a young age. Early diagnosis of BS and prompt multisystem workup including the eyes and joints can improve the patient's outcome.

• Journal of the Korean Arthroscopy Society
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• v.13 no.1
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• pp.72-76
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• 2009

Two diabetes mellitus patients treated by arthroscopy and associated procedure for an infection after arthroscopic rotator cuff repair were involved. The time interval from rotator cuff repair to symptom development was 18 days in average and arthroscopic debridement and associated procedure for infection applied in average 65 days after symptom development. Patient evaluation was done according to the KSS, ASES, UCLA and Constant Score. We used antibiotics for average 22.5 days after arthroscopic debridement and associated procedure, the infection was treated in average 4 months. At final follow-up, the mean KSS score was 82 points, the mean UCLA score was 33 points, the mean ASES score was 91 points, the mean Constant score was 71 points. All infections following arthroscopic rotator cuff repair were cured by arthroscopy and associated procedure. ROM and functional results were much improved, the pain and satisfaction were also much improved.

• Korean Journal of Oriental Medicine
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• v.14 no.2
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• pp.47-66
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• 2008

Background: It is insufficient information that are syndrome differentiations and detail symptoms in Korean. Methods: 19 traditional korean medical agencies collected 190 cases with vital sign, body measurement, patient own symptoms report and doctor diagnosis. And then we analyzed general distributions and comparisons of deficiency and non-deficiency. Results: The most past histories, in order, were the arthritis(20%), gastroenteropathy, hypertension, anemia, diabete mellitus. In chief complains, musculoskeletal occupies 60 percent of the total, and digestive system, head in order. In the syndrome differentiation, it appeared deficiency, spleen, Qi deficiency in order. Age(p=0.000), systolic blood pressure(p=0.044) and the waist-hip ratio(p=0.000) was significantly higher in the deficiency group compared with non-deficiency group. Patients with condition which dislikes the wind and with anxiety and with amazing and fear(驚恐) were significantly more in deficiency group(p=0.029, p=0.017, p=0.044). Conclusions: These statistics are continually revised report and it will be reported comparison of several syndrome differentiations and therapeutic effects by treatment methods.

• Archives of Reconstructive Microsurgery
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• v.17 no.1
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• pp.36-41
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• 2008

Surgical treatment of compressive ulnar neuropathy at the elbow has been performed with a wide variety of techniques. Among these techniques, anterior submuscular transposition of the ulnar nerve has been regarded as the method of choice by many authors. It has many advantages including a low recurrence rate, scar-free vascular bed, and protection from repeated trauma to the nerve. However, anterior submuscular transposition is technically demanding and requires more extensive soft tissue dissection. On the other hand, anterior subfascial transposition is less invasive, requires a relatively shorter operation time than the submuscular technique, and also can be done safely even in patiensts with elbow arthritis. We evaluated the clinical results of anterior submuscular transposition compared with anterior subfascial transposition. Fifteen patients underwent anterior submuscular transposition and ten patients underwent anterior subfascial transposition of the ulnar nerve. The mean follow-up time was 15 months (range 10 to 38 months) in the anterior submuscular transposition group and 7 months (range 6 to 15 months) in the anterior subfascial transposition group. According to the outcome status determination algorithm devised by Mowlavi, 3 patients (20%) showed total relief, 10 patiensts (66.7%) improvement and 2 patients (13.3%) no changes in the anterior submuscular transposition group. In the anterior subfascial transposition group, 2 patients (20%) showed total relief, 7 patients (70%) improvement and 1 patient (10%) displayed no changes. Statistically there was no significant difference of the clinical results between the two surgical techniques. Therefore we would suggest anterior subfascial transposition of the ulnar nerve as a preferred method for treatment of cubital tunnel syndrome.

• Journal of Physiology & Pathology in Korean Medicine
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• v.19 no.5
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• pp.1225-1232
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• 2005

Based on traditional medicine theories, GC, an extract from 5 herbs, has been formulated and prescribed for the treatment of human rheumatoid arthritis(hRA) for many years. The present studies was done to investigate whether GC has inhibitory effects on activation of fibroblast-like sinoviocytes isolated from a RA patient. In tumor necrosis factor-${\alpha}(TNF-{\alpha}$)/ interleukin-IL-$1{\beta}$(IL-$1{\beta}$) treated human sinoviocytes, the mRNA expression of molecular indicators related to pathologic changes of the sinoviocytes were examined using quantitative real-time PCR. The treatment of GC($10{\mu}g/ml$) significantly suppressed the expression of proinflammatory cytokines and chemokines such as $TNF-{\alpha}$, IL-6 and IL-8 compared with the control, but not $IL-1{\beta}$, The mRNA level of intracellular adhesion molecule-1 (ICAM-1) which is known to increase in the activated sinoviocytes of RA patients, was slightly decreased by GC. The expression of NOS-II was considerably reduced, which was accompanied by a decrease in the production of nitric oxide(NO). Furthermore, GC dramatically raised the mRNA levels of tissue inhibitors of matrix metalloproteinase-1 (TIMP-1), while those of matrix metalloproteinase-3 were significantly lowered. Taken together, these data suggested that GC might suppress the activation of sinoviocytes in hRA.

• Health Policy and Management
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• v.21 no.1
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• pp.23-43
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• 2011

Access to health care is complicated to define. It is a multidimensional process. In addition to the matters of quality of care, geographical accessibility and availability of the right type of care, finance, and acceptability are all involved. The purposes of this paper are to measure the geographic distances between patient residency locations and health service organizations in which the patients hadvisited, and to investigate the association between geographical distance measures and variables involved in health service utilization. The study used the first and the second wave of the 2008 Korea Health Panel Survey. The samples of analyses were patients who had visited outpatient or used ambulatory health services, and the total observations (visit numbers) analyzed were 229,128. We divided the samples into a frequent-visit illness group (Group 1) and a non-frequent visit illness group (Group 2) based on over 5,000 total visit numbers. We exploited three level analyses using xtmixed of STATA${\Box}$ 11.1 command with/without interaction terms among age, sex, and occupation. Geographical distances were measured using the Haversine method. Group 1 was tended to older and lower equivalent income than those of Group 2, but the geographic difference were not observed in terms of area deprivation index and standard mortality ratios. Amongst group 1, diabetes mellitus patients travelled far to visit health care organizations, and arthritis patients were more deprived in terms of the personal and areal characteristics. The study revealed that residents in rural areas traveled about 10 times more long distances than those whom lived in larger cities after adjusting for various variables, which we used for analyses. This study contributed to the practical understanding of health service utilizations using empirical analyses, and found that the types of diseases and socioeconomic characteristics of patients tended to define the amount of travel distance to healthcare organizations.

• The Journal of Dong Guk Oriental Medicine
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• v.5
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• pp.79-95
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• 1996

When we see normal gait, gait cycle is seperated as stance phase and swing phase. It needs 6 determinant of gait of pelvic rotation, pelvic tilt, knee joint of stance phase, ankle and foot motion, ankle and knee motion, and pelvic movement to be accomplished. In addition, a joint and muscle action is accomplished biomechanically at the same time with its gait cycle. In oriental medicine, the relationships between chang-fu physiology and meridian physiology are summaried as follows ; ${\bullet}$ chang-fu physiology : Spleen manages the extremities. Liver manages soft tissues. Liver stores blood. Kidney stores essences. Kidney manages bones. ${\bullet}$ meridian physiology : The Leg Greater Yang Meridian and meridian soft tissues The Leg Yang-Myeong Meridian and meridian soft tissues The Leg Lesser Yang Meridian and meridian soft tissues The Leg Greater Yin Meridian and meridian soft tissues The Leg Lesser Yin Meridian and meridian soft tissues The Leg Absolute Yin Meridian and meridian soft tissues Especially, we can find out relations between in a "blood supplied feet can walk well" that explains "blood regulations and by liver nourishing effects"that is the closest concept of muscle. Abnormal gaits are due to three causes as following; first, physical defect secoud, pain third, nervous system or instability of muscle. In oriental medicine, we can know relationship in "atrophy, numbness, stroke, convulsion, muscular dystrophy of knee, rheumatoid arthritis, five causes of infantile growing defects, five causes of softening, sprain". Especially, atrophy is the most important symptom. Gait evaluation should be emphasized where a point can walk 8 feet to 10 feet considering stride width, stride length, the body weight center, stride number, flexion, extension, rotation of a joint as a standard factor. The point is we should find out something strange in a patient's side, front and back view. After that we should find out its cause as an index that we can observe abnormal findings in a joint and muscle.