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Severe Pneumonia Caused by 2009 Pandemic Influenza A (H1N1) Virus in Children and Corticosteroid Treatment (소아에서 2009 신종 인플루엔자 A (H1N1) 중증 폐렴과 스테로이드 치료)

  • Sohn, Yu Rak;Kim, Jong Hee;Ma, Sang Hyuk;Lee, Kyung Yil;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.18 no.2
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    • pp.193-200
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    • 2011
  • Purpose : The effect of corticosteroid on severe pneumonia caused by 2009 pandemic influenza (H1N1) A virus is controversial. This study was aimed to present the effects of early, short-term corticosteroid treatment for severe pneumonia with this virus infection. Methods : A retrospective analysis was performed on severe pneumonia patients (37 patients) who had severe respiratory distress at presentation requiring oxygen therapy and received intravenous methylprednisolone (MP, 8-10 mg/kg, divided in 4 doses/day for 2-3 days) with oseltamivir. The clinical and laboratory characteristics of the patients were evaluated through the medical records and chest radiographic findings. Results : The mean age and male-to-female ratio of the patients were 6.5${\pm}$2.9 years of age, and 3.4:1 (male 29 patients), respectively. The 5-9 aged group was predominant among the age groups (25 patients, 67.6%). Duration of fever prior to admission was 1.4${\pm}$0.6 days and dyspnea developed within 24 h after beginning of respiratory symptoms in all patients. All patients were previously healthy and received oseltamivir within 48 h. Thirteen patients (35.1%) developed dyspnea during oseltamivir treatment. Following MP infusion, all 37 patients including 13 progressive pneumonia patients during oseltamivir treatment showed an immediate halt in the progression of pneumonic infiltration with rapid clinical improvement. There were no side-effects following steroid use. Conclusion : For severe pneumonia patients, early corticosteroid treatment halted clinical exacerbation, and possibly prevented progression to acute respiratory distress syndrome. Further controlled clinical studies are needed for the role of corticosteroids and antivirals on severely affected patients with influenza virus infections.

Abnormal Perfusion on Myocardial Perfusion SPECT in Patients with Wolff-Parkinson-White Syndrome (Wolff-Parkinson-White 증후군 환자의 심근 관류 이상)

  • Kang, Do-Young;Cha, Kwang-Soo;Han, Seung-Ho;Park, Tae-Ho;Kim, Moo-Hyun;Kim, Young-Dae
    • The Korean Journal of Nuclear Medicine
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    • v.39 no.1
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    • pp.9-14
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    • 2005
  • Purpose: Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkinson-White) syndrome. Materials and Methods: Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECG with Fitzpatrick's algorithm or electrophysiologic study and radiofrequency catheter ablation. Results: Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients (mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent ($11.0{\pm}8.5%$, range:$3{\sim}35%$) and mild to moderate severity ($-71{\pm}42.7%$, range:$-2l7{\sim}-39%$) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patient with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Conclusion: Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but it did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome.

Role of Whole Body FDG-PET in the Diagnosis of Hidden Distant Metastasis before Liver Transplantation in Patients with Primary Liver Cancer (고식적 검사로 간외 전이를 진단하지 못한 원발성 간암 환자에서 간이식 전에 시행한 전신 FDG-PET의 역할)

  • Lee, Won-Woo;Ryu, Jin-Sook;Yang, You-Jung;Kim, Jae-Seung;Yeo, Jeong-Seok;Moon, Dae-Hyuk;Lee, Sung-Gyu
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.6
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    • pp.368-380
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    • 2002
  • Purpose: Liver transplantation (LT), one of the therapeutic options of primary liver cancer has been suffering from recurrence caused by metastasis in 8-54% of patients. This study was performed to investigate whether FDG-PET is useful for detecting hidden metastasis in LT candidates. Materials and Methods: Twenty-six patients (male:female=23:3, mean age 55.7 years) underwent FDG-PET. Their previous conventional diagnostic studies (CDS) like abdomen US and CT, chest x-ray and CT, and bone scan were negative (n=22) or equivocal (n=4) for metastasis. Positive FDG-PET findings were confirmed by biopsy or clinical follow-up. Results: Among 4 patients with equivocal metastatic lesions on CDS, 3 had 6 hypermetabolic lesions on FDG-PET, which were confirmed as metastasis and subsequently LTs were cancelled. Of these, 5 lesions were initially negative on CDS. Remained 1 patient underwent LT with a negative FDG-PET result. Among 22 patients without metastasis on CDS, 5 had 7 hypermetabolic lesions on FDG-PET. One of these patients proved to have 2 metastatic lesions, and LT was cancelled. The other 4 patients had S hypermetabolic lesions on FDG-PET, which were confirmed as benign lesions, and 3 patients of them underwent LT. In summary, FDG-PET was useful in avoiding 4 unwarranted LT by detecting unsuspected metastatic lesions on CDS. A total of 17 patients underwent LT. In comparison with pathology, the sensitivity and specificity of FDG-PET for detecting viable primary liver cancer were 55.6% (5/9) and 87.5% (7/8), respectively. Conclusion: FDG-PET can detect additional hidden metastasis and contribute to reducing unwarranted LT in the patients with primary liver cancer.

Surgical Outcome of Patients with Ischemic Cardiomyopathy Selected by the Results of Myocardial Viability by Preoperative F-18 FDG PET (F-18 FDG 양전자단층촬영을 이용한 생존심근 평가 후 수술한 허혈성 심근병증 환자의 수술 결과)

  • Kim, Jae-Sung;Lee, Dong-Soo;Hong, Suk-Keun;Lee, Young-Tak;Kim, Yu-Kyeong;Kim, Youn-Jung;Moon, Keon-Sik;Won, Tae-Kyoung;Hwang, Hweung-Kon
    • The Korean Journal of Nuclear Medicine
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    • v.34 no.4
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    • pp.276-284
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    • 2000
  • Purpose: We investigated the operative outcome after bypass surgery in patients selected using viability criteria on F-18 FDG PET. Materials and Methods: Rest-24hr delay redistribution imaging of Tl-201 SPECT and F-18 FDG PET were performed in 11 patients. Seven of these 11 patients (6 men, 1 woman) were evaluated to have viable myocardium by F-18 FDG PET. Changes in symptoms and left ventricular ejection fraction (LVEF) after operation were evaluated. Results: In seven of 11 patients, a significant amount of viable myocardium was found on F-18 FDG PET and Tl-201 SPECT. Severity of both chest pain and dyspnea improved markedly in all patients. Mean LVEF improved from 22% to 32%. Conclusion: F-18 FDG PET could be used to select the patients who will benefit from coronary artery bypass surgery.

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Difference in F-18 FDG Uptake According to the Patterns of CT-Based Diagnosed Pulmonary Lymphangitic Carcinomatosis in Patients with Lung Cancer (폐암환자에 있어 CT상으로 진단된 폐림프관성암종증의 형태에 따른 F-18 FDG 섭취의 차이)

  • Jun, Sung-Min;Kim, Yong-Ki;Kim, In-Ju;Kim, Seong-Jang;Nam, Hyun-Yeol;Kim, Bum-Soo
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.4
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    • pp.292-300
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    • 2008
  • Purpose: Our purpose was to evaluate F-18 FDG uptake in pulmonary lymphangitic carcinomatosis (PLC) according to CT findings and histology of lung cancer. Materials and Methods: Thirty-three lung cancer patients with PLC were enrolled in this retrospective study. All the patients had a CT-based diagnosis of PLC. Chest CT findings of PLC were classified on the basis of involvement of axial interstitium. We categorized the involvement of axial interstitium as group 1, and the involvement of peripheral interstitium only as group 2. Visual and semiquantitative analyses by F-18 FDG PET/CT were performed in the PLC lesions. At first, we analyzed the F-18 FDG uptake in the PLC by visual assessment. If abnormal uptake was seen in the PLC, we drew regions of interest in the PLC lesions to obtain the maximum SUVs (maxSUVs). Results: Of the 33 patients, 22 had abnormal F-18 FDG uptake in the visual assessment. There was no significant difference in the frequency of abnormal F-18 FDG uptake between group 1 and group 2 (p=0.17), although the frequency of group 1 tended to be higher than group 2 (15/19 (78.9%) in group 1, 7/14 (50.0%) in group 2). However, group 1 had a higher maxSUV than group 2 (p<0.01, group 1: $2.9{\pm}1.4$, group 2: $1.5{\pm}0.6$). There was no significant difference in the frequency of abnormal F-18 FDG uptake and maxSUV among the histology of the lung cancers. Conclusion: The involvement of axial interstitium in the PLC by lung cancer has a higher maxSUV than the involvement of only peripheral interstitium.

A Study on the Riboflavin Intake and EGRAC of Young Healthy Korean Women (한국인 젊은 여성의 리보플라빈 섭취상태와 EGRAC에 관한 연구)

  • Hwang, Geum-Hee;Oh, Seung-Ho;Lim, Hyeon-Sook;Chang, Yu-Kyung
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.20 no.2
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    • pp.103-110
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    • 1991
  • This study was conducted to determine riboflavin status of young healthy Korean women. Eight subjects consumed general Korean diet for 3 weeks. Riboflavin intake was measured during the period and Erythrocyte Glutathione Reductase Activity coefficient (EGRAC) was analyzed at the end of experimental period. The subjects who showed EGRAC value above 1.20 were supplemented 6 mg riboflavin per day for 1 week. The average age of subjects was 22.1 years old, height was 154.4cm, weight was 49.2kg, chest circumference was 81.2cm, the sum of skinfold thickness of 3 parts was 79.5mm and Body Mass Index(BMI) was 20.6. Hemoglobin concentration was 13.0g/100ml, hematocrit value was 44.0% A/G ratio was 1.4, and the activity of sGOT, sGPT, alkaline phosphatase was 14.3, 11.0 and 6.5, respectively. The average daily intake of energy, protein and riboflavin was 1745kcal, 56.1g and 1.14mg, respectively. The mjor source of riboflavin were milk, egg, Korean cabbage, rice, beef and so on. The average EGRAC value was 1.2748. percentages of subjects who showed EGRAC value above 1.20 was 65.2%. After oral administration of 6mg riboflavin, the EGRAC value of all these subjects was returned to normal range. Riboflavin intake was correlated positively with energy as well as protein intake, and correlated negatively with EGRAC value. However, riboflavin intake per 1,000kcal was not correlated with EGRAC value.

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Social Worker's Experience of NEET Youth Support Project : Focusing on the Vision Plan (청년니트(NEET) 지원 사업에 대한 종합사회복지관 사회복지사의 경험 : 희망플랜 사업을 중심으로)

  • Noh, Hyejin;Lee, Bongjoo;Park, Mihee;Park, Hojun
    • Korean Journal of Social Welfare Studies
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    • v.49 no.2
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    • pp.125-157
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    • 2018
  • In the reality that the seriousness and concern about the youth problem is increasing, this study focuses on the vision plan project supporting the NEET youth in the social welfare field. Therefore, this study analyzed how the social workers recognized the NEET problem before participating in the project, what difficulties they experienced in the process of the project, and how they coped with these difficulties. The results of the study are as follows. Social workers were saddened by the seriousness of the youth problem before their participation, but they recognized that there was no way to solve it and many social workers were not fully aware of the youth or NEET issues. In this context, in the course of running a project with NEET youth, social workers experienced difficulties due to the nature of the NEET youth, difficulty in forming a relationship with NEET youth, and difficulties for young people not to spend time in the program. And social workers also faced difficulties due to the lack of know-how in the project, difficulties in operating the center alone, and difficulty in achieving employment goals. In the process of coping with these difficulties, social workers have actively sought, persuaded and supported the NEET youths to participate in the project, adapted the time, place and method to the youth, and removed the stigmatization element in the project. They also worked closely with local residents, local institutions and municipalities, formed networks, and changed the viewpoint of providing work experience rather than getting young people, but seeing long-term outcome. As a result, social workers have experienced not only individual change but also social welfare organization, field, community and local institutional change. Based on these results, this study suggested that the social welfare practice field should provide various activities in the process of supporting the youth gap year policy. In addition, this study suggests that the social workers play a role in connecting various actors rather than suppliers when working with young people, and that the social welfare field should expand the scope of project to include youth.

Improvement of patient's quality of life by improving patient's set-up line in radiotherapy (방사선 치료 시 환자 Set-up Line 개선을 통한 암환자 삶의 질 만족도 향상)

  • Choi, Jin Hyuk;Ahn, Woo Sang;Lee, Woo Seok;Kim, Dae Yong
    • The Journal of Korean Society for Radiation Therapy
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    • v.30 no.1_2
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    • pp.185-189
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    • 2018
  • Purpose : We evaluated the quality of life satisfaction of patients with radiation therapy while maintaining the set-up line. Materials and Methods : We retrospectively reviewed 60 patients who visited our clinic in January, 2018. The most common complaint was the inconvenience of not being able to wash during treatment (64 %), and a surgical tape was placed on the Set-up Line to help patients wash during the treatment period. A total of 50 patients who underwent surgical tape were evaluated on a 5-point scale (1 point was very unsatisfactory, 2 points were unsatisfactory, 3 points were average, 4 points were satisfied, 5 points were very satisfied). Forty patients out of 50 responded to the first treatment, and 10 patients underwent treatment. Results : In the first survey, 68 % of the patients and 32 % of the males were aged 34 %, 50~60 % and 38 %, respectively. Treatment areas were breast (57 %), chest (13 %), pelvis (10 %). The results of the second questionnaire after applying the surgical tape showed that 25 of the 40 patients and 15 of the male patients were treated. The treatment area was 22 breast and 18 pelvic areas. In the satisfaction of the 5-point scale, 5 to 15 points were satisfied with 1-3 points, and 4-5 points with 35 points (1 point 2 points, 2 points 2 points, 3 point 1 points, 4 point points 17 point points, % And 43 %, respectively. The results of the questionnaire survey of patients who were applied during the treatment showed that 9 out of 10 women and 1 male were treated. The treatment area was 8 breast and 2 pelvic areas. One point was satisfied with one point, and five points with nine points were satisfied with 90 %. Conclusions : The importance of improving the quality of life of patients with cancer is also important. After applying the surgical tape, 88 % of the patients who started the treatment and 90 % of the patients who applied during the treatment were satisfied. Particularly, patients who applied during treatment showed higher satisfaction. If this is not possible for all patients, selective application to patients with discomfort will be helpful in improving the quality of life of cancer patients.

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A Statistical Study of the Foreign Bodies in the Food and Air Passages for past 4 years and 5 months (과거 4년 5개월간 본교실에서 취급한 식도 및 기도이물의 통계적 고찰)

  • 전지일;김성일;조현상;김정원;최태규;김진구;최병익;임현준;김영학
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1976.06a
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    • pp.87.4-88
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    • 1976
  • The statistcal study was done on 81 cases of the foreign bodies in the food passages (73 cases) and air passages (8 cases), who had visited the Dept. of Otolaryngology of Kyung Hee Medical Center and treated endoscopically, from Nov. 1971 to Mar 1976. The results were as follows, 1) The incidence of esophageal foreign bodies (73 cases) in order of frequency was coin (61 cases; 83.6%), bone (6 cases; 8.2%), food particles (3 cases; 4.1%), discs (2 cases), and other metals (l case). The incidence of foreign bodies in the air passages (8 cases) was food particles (3 cases; 37.5%), pointed metal (2 cases; 25%), plastic pencil cap (l case), plastic ring (1 case), and wood piece (1 case) in order. 2) In sex distribution, 51 cases (62.9%) were males and 30 cases (37.1%) were females, and the ratio between males and females was about 1.7 : 1.3. In the age incidence, 69 cases (82.5%) of all foreign bodies were under 5 years of age, and especially, coin cases were 59 cases (96.7%) and the highest was 8 years of age, lowest was 11 months of age. 7 cases (87.5%) of all airway foreign bodies were under 10 years of age. 4) The ratio between the food passages(73 cases) and the air passages (8 cases) was about 9 : 1. In the location of the foreign bodies of the food passages, 66 cases (90.4%) were in the first esophageal narrowing, 5 cases (6.9%) in the second narrowing, and 2 cases (2.7%) in the third narrowing. In the air passages, the frequent sites were trachea (5 cases; 62.5%), larynx (2 cases), and bronchus (1 case) in order. 5) In duration of lodgement, 63 cases (86. 3%) of esophageal foreign bodies were removed within 24 hours, and one case was removed within 16 days. The number of cases lodged within 24 hours were 4 cases (50%). in the air passages and one case was removed within 18 days. 6) In treatment, 37 cases (50.7%) of esophageal foreign bodies were extracted by modified upper esophagoscopy, 33 cases (42.5%) by esophagoscopy under the local anesthesia, 3 cases (4.1%) by esophagoscopy under the general anesthesia. 8 cases of the coin cases were passed into the stomach during the endoscopic examination. Laryngeal foreign bodies (2 cases; 25%) were extracted by laryngoscopy under the local anesthesia. 2 cases (40%) of tracheal foreign bodies by Bronchoscopy with tracheotomy under the local anesthesia, 3 cases (60%) by Bronchoscopy under the general anesthesia, and bronchial foreign body (1 case) by open thoracotomy under the general anesthesia, at the Dept. of Chest surgery.

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A Literature Study about Comparison of Eastern-Western Medicine on the Acne (여드름의 동(東)·서의학적(西醫學的) 문헌(文獻) 고찰(考察))

  • Joo, Hyun-A;Bae, Hyeon-Jin;Hwang, Chung-Yeon
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.25 no.2
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    • pp.1-19
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    • 2012
  • Objective : The purpose of this study is to investigate about comparison of Eastern-Western medicine on the acne. Methods : We searched Eastern and Western medicine books for acne. We analyzed these books and examined category, definition, etiology, classification, internal and external methods of treatment of acne. Results : The results were as follows. 1. In Eastern medicine, Acne belongs to the category of the Bunja(粉刺), Jwachang(痤瘡), Pyepungbunja(肺風粉刺). In Western medicine, the other name of Acne is acne vulgaris. 2. In Eastern medicine, the definition of Acne includes manual extraction of comedones and skin appearance. In Western medicine, Acne is a common skin disease during adolescence and a chronic inflammatory disease of pilosebaceous unit of self localization. It is characterized by noninflammatory, open or closed comedones and by inflammatory papules, pustules, and nodules and it affects the areas of skin with the densest population of sebaceous follicles, these areas include the face, neck, back, and the upper part of the chest. 3. In Eastern medicine, the cause and mechanism of Acne arose from the state of internal dampness-heat and spleen-stomach internal qi deficiency due to dietary irregularities and then invaded external pathogen such as wind-dampness-heat-cold-fire in lung meridian lead to qi and blood heat depression stagnation. So it appears in skin. In Western medicine, the etiology and pathogenesis of Acne is clearly not identified, but there are most significant pathogenic factors of blood heat depression stagnation. So it appears in skin. In Western medicine, the etiology and pathogenesis of Acne is clearly not identified, but there are most significant pathogenic factors of Acne; Androgen-stimulated production of sebum, hyperkeratinization and obstruction of sebaceous follicles, proliferation of Propionibacterium acnes and inflammation, abnormaility of skin barrier function, genetic aspects, environmental factors etc. 4. In Eastern medicine, differentiation of syndromes classifies clinical aspects, and cause and mechanism of disease; the former is papular, pustular, cystic, nodular, atrophic, comprehensive type; the latter is lung blood heat, intestine-stomach dampness-heat, phlegm-stasis depression, thoroughfare-conception disharmony, heat toxin type. In Western medicine, it divides into an etiology and invasion period, and clinical aspects; Acne neonatorum, Acne infantum, Acne in puberty and adulthood, Acne venenata; Acne vulgaris, Acne conglobata, Acne fulminans, Acne keloidalis. 5. In Eastern medicine, Internal methods of treatment of Acne are divided into five treatments; general treatments, the treatments of single-medicine and experiential description, the treatments depending on the cause and mechanism of disease, and clinical differentiation of syndromes, dietary treatments. In Western medicine, it is a basic principles that regulation on production of sebum, correction on hyperkeratinization of sebaceous follicles, decrease of Propionibacterium acnes colony and control of inflammation reaction. Internal methods of treatment of Acne are antibiotics, retinoids, hormone preparations etc. 6. In Eastern medicine, external methods of treatment of Acne are wet compress method, paste preparation method, powder preparation method, pill preparation method, acupuncture and moxibustion therapy, ear acupuncture therapy, prevention and notice, and so on. In Western medicine, external method of treatments of Acne are divided into topical therapy and other surgical therapies. Topical therapy is used such as antibiotics, sebum regulators, topical vitamin A medicines etc and other surgical therapies are used such as surgical treatments, intralesional injection of corticosteroids, skin dermabrasion, phototherapy, photodynamic therapy, and so on. Conclusions : Until now, there is no perfect, effective single treatment. We think that Eastern medicine approach and treatment can be helpful to overcome the limitations of acne cure.