• 대한한방소아과학회지
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• 제16권2호
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• pp.129-141
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• 2002

The Purpose of this study was to investigate infancy patients who had visited Oriental Medicine Hospital, and so to consider a counterplan by oriental medicine. The study was composed of 101 new infancy patients who had visited Dongguk Kyeongju Oriental Medicine Hospital during 1 year from January 2001 to December 2001. The results were as follows : 1. Male children are 65(64.3%), female children are 36(35.6%), male to female ratio is 1.8: 1. 2. In age distribution, 1 month 5.9% ; 2 month 10.9%, 3 month 4.0%, 4 month 11.9%, 5 month 5.9%, 6 month 9.9%, 7 month 10.9%, 8 month 10.9%, 9 month 10.9%, 10 month 14.8%, 11 month 4.0%. 3. According to systematic division of the chief complaint, respiratory diseases are 37.6%, digestive diseases are 25.7%, nervous diseases are 21.8%, urogenital diseases are 1.0%, musculoskeletal diseases are 1.0%, dermatologic diseases are 7.9%, infirmity diseases are 3.0%. 4. In treatment, herb-medication is 86.1%, consultation is 7.9%, acupuncture is 17.8%, moxibution is 2.0%, venesection is 14.8%, aromatherapy is 4.9%, chimsband is 16.8%.

• Journal of Chest Surgery
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• 제56권3호
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• pp.155-161
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• 2023

Background: Surgical closure of an atrial septal defect (ASD) is infrequently indicated during infancy. We evaluated the clinical characteristics and outcomes of patients who underwent surgical ASD closure during infancy. Methods: A single-center retrospective review was performed for 39 patients (19 males) who underwent surgical ASD closure during infancy between 1993 and 2020. The median body weight percentile at the time of operation was 9.3. Results: During a median follow-up of 60.9 months, 4 late deaths occurred due to chronic respiratory failure. A preoperative history of bronchopulmonary dysplasia (BPD) was the only risk factor for late mortality identified in Cox regression (hazard ratio, 3.54; 95% confidence interval [CI], 1.75-163.04; p=0.015). The 5-year survival rate was significantly lower in patients with preoperative history of BPD (97.0% vs. 50.0%, p<0.001) and preoperative ventilatory support (97.1% vs. 40.4%, p<0.001). There were significant postoperative increases in left ventricular end-diastolic (p=0.017), end-systolic (p=0.014), and stroke volume (p=0.013) indices. A generalized estimated equation model showed significantly better postoperative improvement in body weight percentiles in patients with lower weight percentiles at the time of operation (<10th percentile, p=0.01) and larger indexed ASD diameter (≥45 mm/m², p=0.025). Conclusion: Patients with ASD necessitating surgical closure during infancy are extremely small preoperatively and remain small even after surgical closure. However, postoperative somatic growth was more prominent in smaller patients with larger defects, which may be attributable to an increase in postoperative cardiac output due to changes in ventricular septal configuration. The benefits of ASD closure in patients with BPD are undetermined.

• Journal of Chest Surgery
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• 제27권1호
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• pp.24-30
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• 1994

Eighteen infants with a large ventricular septal defect[VSD] underwent primary surgical repair from January 1986 to December 1992. Operation was done because of failure to thrive, medically intractable heart failure, recurrent pneumonia, increased pulmonary vascular resistance[PVR]. Four patients[22.2%] died in the early postoperative period. Relief of heart failure and normalization of growth and weight gain was evident in all survivor. There was no late postoperative death. The results of primary surgical repair of VSD in infancy are compared with those of palliative pulmonary artery banding[PAB] and of VSD closure after PAB. Twenty-seven patients with isolated VSD or with VSD associated with atrial septal defect, patent ductus arteriosus, or coarctation of the aorta underwent initial palliative PAB. There were 3 early postoperative deaths[11.1%]. Severe elevation of PVR persisted in two patients. Closure of VSD and pulmonary artery debanding was done in twenty patients, with 2 early postoperative deaths[10.0%]. Placement of the PAB too close to the pulmonary annulus necessitated trasannular patching in one patient, but any problem caused by migration of the band was not developed. It is concluded that primary surgical repair of VSD in infancy is reasonable and that PAB is indicated only for those patients less than 6 months old with a complicated defect or in an emergency situation.

• Journal of Chest Surgery
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• 제48권1호
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• pp.7-12
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• 2015

Background: Mitral regurgitation is one of the leading causes of cardiovascular morbidity in pediatric patients with Marfan syndrome. The purpose of this study was to contribute to determining the appropriate surgical strategy for these patients. Methods: From January 1992 to May 2013, six patients with Marfan syndrome underwent surgery for mitral regurgitation in infancy or early childhood. Results: The median age at the time of surgery was 47 months (range, 3 to 140 months) and the median follow-up period was 3.6 years (range, 1.3 to 15.5 years). Mitral valve repair was performed in two patients and four patients underwent mitral valve replacement with a mechanical prosthesis. There was one reoperation requiring valve replacement for aggravated mitral regurgitation two months after repair. The four patients who underwent mitral valve replacement did not experience any complications related to the prosthetic valve. One late death occurred due to progressive emphysema and tricuspid regurgitation. Conclusion: Although repair can be an option for some patients, it may not be durable in infantile-onset Marfan syndrome patients who require surgical management during infancy or childhood. Mitral valve replacement is a feasible treatment option for these patients.

• Journal of Chest Surgery
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• 제16권3호
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• pp.322-330
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• 1983

TAPVC represents 1 to 4% of all congenital cardiac defects. Generally severe and refractory cardiac failure develops in the majority of patients in the early infancy. In a small minority of patient, they are relatively asymptomatic in infancy, but symptoms will develop of necessity In the later life. Our three cases had dyspnea on exertion and cyanosis and had a history of frequent respiratory infections. All 3 cases had the typical showman configuration on roentgenograms of the chest. Current surgical therapy has greatly altered the unfavorable course of these patients after institution of extra-corporeal circulation. We have experienced three cases from June, 1973 to May, 1983, the patients were undergone complete repair with extracorporeal circulation at the Department of Thoracic and Cardiovascular Surgery in the Yonsei University. The ages ranged from 12 years to 14 years, all cases were supracardiac type of TAPVC. Only one case died due to bleeding from anastomosis site between LA and pulmonary venous trunk. In the remaining two patients with complete corrections of TAPVC, there was excellent relief of symptoms such as dyspnea and cyanosis. Their postoperative course have been good during follow-up.

• 대한기관식도과학회지
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• 제16권2호
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• pp.115-120
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• 2010

Background: Pediatric deep neck infection can cause critical complications in that they are seldom able to verbalize symptoms or cooperate with physical examination. The objective of this study is to identify the clinical characteristics according to age. Material and Method: A retrospective study was performed on 26 cases with pediatric deep neck infection during 12 years. Patients were classified infancy group (1-7 yr, 19.2%), preschool age group (7-15 yr, 30.8%) and school age group (15 yr-, 50%). We analyzed the age, sex, sites of abscess, predisposing factors, symptoms and compared onset, hospital date, laboratory and outcomes at each group. Results: In pediatric patients with deep neck infection, the age distribution was 18 males (69.2%) and 8 females (30.8%), the mean age was 7.4 years. The most common infection site was the anterior cervical triangle and submandibular space (19.2%). The most commonly known associated preceding disease was upper viral infection (34.6%), but we could not find the preceding diseases in most of cases (50%). Neck swelling (69.2%) was the most frequent symptom. The mean age of patients who performed neck CT was 8.23 years and neck US was 2.75 years. The younger patients were preferred to perform the neck US than the neck CT (p=0.022). The mean time from disease onset to admission was 9 days in the infancy, 5.5 days in the preschool aged and 5 days in the school aged group. The surgical treatment was performed in 30.8% of school aged, 62.5% of preschool aged and 100% of infancy group. Surgical treatment was preferred to younger patients (p=0.026). Conclusion: Abscess sites, size, and antibiotics susceptibility and especially patient age should be carefully considered in treating pediatric deep neck infection.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권3호
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• pp.175-179
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• 2015

Purpose: Infants with Alagille syndrome (AGS) are occasionally misdiagnosed as biliary atresia and subsequently undergo Kasai operation. The purpose of this study was to investigate the outcome of patients with AGS who had previously received Kasai operation during infancy. Methods: This retrospective study was conducted at the Department of Pediatrics, Samsung Medical Center. We compared the prognosis and mortality between those who had undergone Kasai operation during infancy (Kasai group) and those who had not (non-Kasai group). Results: Among the 15 children with AGS, five had received Kasai operation, while 10 had not. All subjects in the Kasai group revealed neonatal cholestasis, while 70% of the non-Kasai group showed neonatal cholestasis. Liver transplantation was performed in 100% (5/5) among the Kasai group, and 20.0% (2/10) among the non-Kasai group (p=0.007). Mortality was observed in 60.0% (3/5) among the Kasai group, and 10.0% (1/10) among the non-Kasai group (p=0.077). Conclusion: Although overall mortality rate did not significantly differ between the two groups, the proportion of patients receiving liver transplantation was significantly higher in the non-Kasai group. The relatively worse outcome in AGS patients who had received Kasai operation may be due to the unfavorable influences of Kasai operation on the clinical course of AGS, or maybe due to neonatal cholestasis, irrespective of the Kasai operation.

• Journal of Chest Surgery
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• 제29권3호
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• pp.271-277
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• 1996

영아기에는 수술에 따른 위험 도가 높기 때문에 가능하면 수술을 피 해야 하지만, 제한된 경우에서 비 교적 큰 심실중격결손을 가진 영아에서도 개심술을 시행하게 된다. 따라서, 난치성 울혈성 심부전, 폐동 맥고혈압, 발육부진, 그리고 반복되는 호흡기 감염이 있는 경우에는 개심술을 시행하게 된다. 저자들은 1991년 1월부터 1994년 12월까지 31례의 영아 심실중격결손환아에서 개심술을 시행하였다. 연령분포는 6개월에서 12개월까지 였고 평균연령은 9.2개 월이 었다. 31례중 남자가 23례 였고, 여자가 8례 였다. 평균 체중은 7.4킬로그램이 었다. 심실중격 결손의 가장 흔한 형 태는 막상주위 형 (64.5%)이었으며, 동반 심기 형은 17례 (55.8%)에서 있었다. 승모판 폐쇄부전이 가장 많았으며 (16.1%), 동맥관개존이 그 다음이 었다 (12.8%). 심 도자검 사결과에서 폐-체 혈류량비, 폐-체 혈압비, 폐-체저 항비는 각각 2.1∼3.0, 0.70이상, 0. 1∼0.25사이 에서 가장 많았다. 수술적응증에서는 폐동맥고혈압이 20례, 울혈성 심부전이 3례, 반복되는 호흡기 감염이 10El,그리고 발육부전이 14례로 나타났다. 가장혼한심장절개법과수술방법은우심방 절개 (58%)와 다크론패취봉합(94%)이 었다. 술후 합병증은 10례 (32%)에서 있었으며, 사망률은 12.9% (4례)이었다 사망례는8개월, 8킬로그램이하의 영아에서 있었다.

• Neonatal Medicine
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• 제15권1호
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• pp.75-79
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• 2008

목 적 : 혈변을 보였으나 확진 할 수 없었던 4개월 이하의 영아에서 내원 당시의 임상 상태 및 2년 후의 추적관찰을 통해 얻은 정보로 임상 소견 및 향후 알레르기 질환의 발현 여부에 대하여 알아보고 치료 방침 설정에 도움이 되고자 본 연구를 시행하였다. 방 법 : 신생아와 조기 영아기에 혈변을 보았던 환아들 중 감염 및 수술적 질환을 제외한 환아의 임상소견 및 2년 후의 추적관찰을 시행하였다. 결 과 : 모든 환아에서 RAST 우유 검사는 음성이었고, 환아들 모두는 자연 호전 되었으며, 2년 후 추적관찰 결과 예후는 양호하였다. 내원 당시의 총 호산구수 증가 유무에 따른 2년 후의 알레르기 성향에서 차이를 보이지 않았다. 결 론 : 신생아와 조기 영아기에 혈변을 보았던 환아들 중 감염 및 수술적 질환을 제외한 환아의 임상양상 및 예후는 모두 양호하였고, 특별한 치료 없이 모두 호전되었으므로 불필요한 치료를 배제할 수 있을 것이다.

• 대한유전성대사질환학회지
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• 제15권2호
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• pp.78-86
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• 2015

목적: 호모시스틴뇨증은 cystathionine ${\beta}$-synthase의 결핍으로 유발되는 질환이다. 본원에서 치료받고 있는 총 6명 환자들의 임상양상과 유전자 분석을 시행하였다. 방법: 1992년 1월부터 2015년 3월까지 본원에서 전형적 호모시스틴뇨증으로 진단되어 치료 중인 총 6명의 환자들을 대상으로 후향적으로 임상적, 생화학적, 유전자적 분석을 하였다. 결과: 총 6명의 환자가 본 연구에 포함되었으며 이 중 3명은 영아기에 발견되었고, 나머지 3명은 7세 이후에 진단되었다. 영아기에 진단되어 치료를 받은 환자들은 정상 인지기능을 보였고, 7세 이후에 진단된 환자들은 다양한 정도의 지적 장애가 있었다. 골감소증이 6명 중 2명의 환자에서 발견되었다. 혈전 색전증이나 경련, 수정체 탈구 같은 주요한 합병증은 7세 이후에 진단된 군에만 있었다. 유전자 검사에서 모두 cystathionine ${\beta}$-synthase 유전자의 돌연변이를 확인하였다. 본 연구에 포함된 6명은 현재 메티오닌 제한 식이를 하면서 엽산과 베타인, 비타민 B6, 메틸코발라민을 복용 중이다. 결론: 6명의 전형적 호모시스틴뇨증 환자들을 길게는 23년 동안 추적 관찰하였다. 신생아 대사 이상 검사에서 발견된 환자들은 합병증 없이 성장하고 있으나, 7세 이후에 진단된 환자들은 100% 수정체 탈구가 있었고 각종 합병증이 동반되었다. 따라서 전형적 호모시스틴뇨증의 예후에는 무엇보다 조기 진단이 중요하며 이는 현재 국내에서 시행되는 신생아 대사 이상 검사의 중요성을 설명하는 것이라 하겠다.