• Pediatric Infection and Vaccine
• /
• 제22권2호
• /
• pp.106-112
• /
• 2015

목적: 장기간의 항생제 치료는 중이염 어린이 환자의 중이액으로부터 원인균이 배양되는 것을 방해한다. 본 연구는 배양 음성 중이액으로부터 분자적 진단에 의한 신속한 균 검출 가능성 여부를 확인하고자 하였다. 방법: 폐구균 lytA 유전자를 표적으로 하는 PCR과 LAMP로 민감도와 특이도를 비교 결정하고, 임상중이액에서의 폐구균 검출에 적용하였다. 결과: PCR 기법에 의한 폐구균 검출 최소한계는 약 $10^4$ 집락형성단위(CFU)이고, LAMP의 검출 최소한계는 10 CFU에서 결정되었다. 한편 두 가지 검사법 모두 Haemophilus influenzae 와 Moraxella catarrhalis 에 대해 $10^6$ CFU 이상에서도 DNA를 증폭하지 않았다. 22개의 배양음성 중이액 중에서 12개 검체가 LAMP-양성(54.5%, 12/22)으로 확인되었고, 이들 12개 LAMP-양성 검체 중, 3개의 검체만이 PCR-양성으로 확인되었다(25%, 3/12). 본 연구의 결과는 LAMP 기법의 폐구균 검출 해상력이 PCR 기법에 비교하여 4배 이상 높음을 보여준다(P<0.01). 결론: lytA -특이 LAMP 기법은, 중이액 내의 타 병원균과는 교차반응 없이 10 CFU 폐구균의 DNA를 검출할 수 있는 고해상 기술로서, 중이액 폐구균 검출 및 폐구균 백신의 보급에 따른 백신 효과 평가에 적용이 기대된다.

• 대한한방소아과학회지
• /
• 제12권1호
• /
• pp.111-131
• /
• 1998

1. In oriental medicine, the case of sinusitis can be explained, not only external invasion such as PUNG HAN(wind-cold), PUNG YUL(wind-hot), SHUP YUL(damp-heat), but also functional disorder of internal organ such as spleen(脾), lung(肺), kidney(腎) The western medicine classified the cause of sinusitis as two factors. That is bacterial infection factor-Haemophilus influenza, streptococcus pyogeues, streptococcus pneumonia- and viral infection factor-Rhinovirus, parainfluenza, Echo28, Coxsacki21, Sinusitis is complicated to allergic rhinitis, chronic otitis media purulent, chronic tonsilitis, sinubronchitis. On the condition of nasal septum deformity, turbinates deformity, nasal septum deviation, sinusitis can be developed. the predisposing factors of sinusitis is swimming, air pollution, malnutrition, shortage of immunity.2. According to survey, sinusitis occurred that children from 4 to 12 years old and from 5 to 7 years old occupied 70% 3. From the past history data, they experienced chronic tonsillar hypertropy(20%), otitis media, atopic dermatitis, allergic rhinitis, bronchial asthma, pneumonia, bronchiolitis, chronic sore throat, urticaria, milk allergy in sequence. 4. the symptoms of sinusitis is nasal obstruction, postnasal dripping, purulunt(yellow)or white discharge, cough, nose bleeding in sequence. nasal obstruction take the portion of 95%, postnasal dripping 65%, night time or early morning cough 60%. 5. The suffering period of sinusitis is 6 month minimum, 4 years maximum, most cases are included in a year. The suffering period of children was shorter than adult. 6. Diagnosis depend on inspection of nasal cavity, postnasal dripping, X-ray finding. 75% of patient(15case) showed both maxillary sinusitis, 25%(5cases) showed left or right maxillary sinusitis. 7. Treatment of oriental medicine, consist of Herb-medicine, acupuncture and exposing of Lazer beam. Kamihyunggyeyungyotang(加味荊芥蓮翹湯) is administered mainly as the medical therapy, Kamigwaghyangjeungkisan(加味藿香正氣散) Kimizwakwieum(加味左歸飮), Kamihyangsosan(加味香蘇散) is administered for a additional symptoms which occurred by influenza recurrence. Kamijeonxibackchulsan(加味錢氏白朮散) is administered to treat gastro-intestine trouble patients who have sinusitis. 8. The period of treatment is varied with patient conditions and X-ray finding. The minimal period is 35days, maximal period is 202days. So it took about 86days in average and about 50% of patient(10cases) is recovered in one or two month.

• Clinical and Experimental Pediatrics
• /
• 제59권sup1호
• /
• pp.49-52
• /
• 2016

X-linked agammaglobulinemia (XLA) is a hereditary humoral immunodeficiency that results from Bruton's tyrosine kinase (BTK ) gene mutations. These mutations cause defects in B-cell development, resulting in the virtual absence of these lymphocytes from the peripheral circulation. Consequently, this absence leads to a profound deficiency of lg all isotypes, and an increased susceptibility to encapsulated bacterial infections. A 15-month-old Korean boy presented with recurrent sinusitis and otitis media after 6 months of age, and had a family history of 2 maternal uncles with XLA. Laboratory tests revealed a profound deficiency of Ig isotypes, and a decreased count of $CD19^+$ B cells in the peripheral circulation. Based on his family history and our laboratory test results, he was diagnosed with XLA. We performed BTK gene analysis of peripheral blood samples obtained from family members to confirm the diagnosis. Mutational analysis revealed a novel hemizygous frameshift mutation (c.82delC, p.Arg28Alafs*5), in the BTK gene. His mother and maternal grandmother were heterozygous carriers of this mutation and his two maternal uncles were hemizygous at the same position. After XLA diagnosis, intravenous immunoglobulin (400 mg/kg, monthly) treatment was initiated; recurrent sinusitis and otitis media were subsequently brought under control. To our knowledge, this is the first reported case of a Korean pedigree with a novel mutation in the BTK gene.

• 대한기관식도과학회:학술대회논문집
• /
• 대한기관식도과학회 1978년도 제12차 학술대회연제 순서 및 초록
• /
• pp.8.3-8
• /
• 1978

부음기관의 기능이 정상인 경우 1,000Hz 이하의 저음역에서 골도관치는 외이도를 폐새 하였을 때와 개방하였을 때 약 20dB의 차이를 나타낸다. 그러나 외이도를 폐색하였을 때나 개방하였을 때 골도관치에 변화가 없으면 전음기관에 병변이 있음을 의미한다. 1891년에 Bing이 처음으로 외이도폐색에 의한 골도검사를 발표한 이래 여러 학자들에 의하여 본검사가 유용한 임상경력검사의 한방법으로서 인정되고Bing test로 알려지고 있다. Sullivan은 1947년에 250Hz, 500Hz, 1,000Hz에서 외이도를 폐색하였을 때와 개방하였을 때의 골도관치의 차이를 합한 것을 "Occlusion Index"라고 명명하였다. 이에 저자들은 bing test의 임상청각학적 의의를 검토하고자 정상인 40이, 만성중이염환자 20이, 감각신경성난청환자 14이를 대상으로 순음청력검사, Bing test및 impedance audiometry를 시행하고 occlusion index와의 상관관계를 검토하여 다음과같은 결과를 얻었다. 1. Occlusion index는 정상인 40좌에서는 $33.10\pm1.68dB,$ 만성중이염환자 20이에서는 $3.10\pm0.69dB,$ 감각신경성난청환자 14이에서는 28.10=4.05 dB이었다. 2. 정상인 40이의 static compliance는 범위가 0.22~0.75cc, 평균치가 0.64cc, 5.D가 0.05이었다. 3. Static compliance가 작을수록 occlusion index는 컸고, static compliance가 클수록 occlusion index 는 작아지는 영향을 나타내고 있음을 관찰하였다.

• 대한기관식도과학회:학술대회논문집
• /
• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
• /
• pp.19.2-19
• /
• 1983

만성중이염은 이비인후과의 가장 흔한 질환 중의 하나로 이에 대한 수술요법은 여러 가지 방법이 많이 발표되고 있으나 아직까지 어려운 점이 많이 있다고 하겠다. 저자들은 1981년 2월부터 1983년 2월 까지 부산성분도병원 이비인후과에서 만성중이염이란 진단하에 수술을 받은 환자 128예에 대해서 임상적 세균학적 관찰을 실시하여 다음과 같은 결론을 얻었다. 1) 성별과 연령비는 여자가 68예(53.1%), 남자가 60예 (46.9%), 또한 연령별로는 20대가 48예(37.5%), 10대가 37예(28.9%) 그리고 30대가 27예(21.1 %) 의 순서였다. 2) 환측별은 우측이 71예(55.5 %), 좌측이 57예(44.5 %) 이었다. 3) 수술전청력검사상 중등도의 손실이 64예 (50%)로 가장 많았고 다음으로 경도손실이 32예 (25 %)이었다. 4) 고막천공의 상태는 중심성천공이 65예(50.8%), 전결손이 44예 (34.4%), 이완부천공이 12예 (9.4%) 그리고 변연성천공이 7예 (5.4%)이었다. 5) 진주종이 전체의 36.7 %인 47예에서 나타났다. 6) 피부절개 및 수술경로는 postaural incision이 123예(96.1%) 이었다. 7) 국소마취가 95예(74.2 %) 이었다. 8) 수술방법은 intact canal wall tympanoplasty with mastoidectomy 가 53예 (41.4 %), tympanoplasty without mastoidectomy가 42예(32.8%) modified radical mastoidectomy 23예 (18%) 그리고 radical mastoidectomy가 10예(7.8%) 이었다. 9) Culture를 시행하여 분리된 균주 93종 중 proteus가 29종(31.2 %), staphylococcus가 27종(28.7%), pseudomonas가 22종(23.7%) 그리고 streptococcus가 7예(7.5%)이었다.

• Pediatric Infection and Vaccine
• /
• 제24권2호
• /
• pp.87-94
• /
• 2017

목적: 상기도 감염인 소아에게 항생제를 처방하는 것은 아직도 많은 진료실에서 이루어지고 있다. 이 연구는 역전사 중합효소연쇄반응 검사로 호흡기 바이러스가 확인된 이후에도 항생제를 사용한 소아 환자들의 임상적 특징을 조사하고자 하였다. 방법: 2013년 1월부터 2014년 11월에 고신대학교 복음병원 소아청소년과에 상기도 감염으로 입원한 환자 중 역전사 중합효소연쇄반응을 시행한 환자들을 대상으로 후향적 의무기록 분석을 통해 평가하였다. 결과: 상기도 감염으로 진단받은 393명 중 전체 환자 연령의 중앙값은 23개월이었다. 입원 당시 항생제를 처방받은 환자(79명, 20.1%)와 항생제를 처방받지 않은 환자들의 임상적 요인을 비교할 때, 중이염 또는 부비동염의 동반, 높은 고감도 C-반응단백질의 수치가 항생제 처방과 의미 있게 관련 있었다(P<0.001). 입원하여 항생제를 사용하던 중 역전사 중합효소연쇄반응 방법으로 호흡기 바이러스가 확인되었지만, 항생제를 계속 사용한 환자는 44명 중 28명(63.6%)이었다. 항생제를 계속 사용한 환자는 항생제를 중단한 환자와 비교할 때 중이염 동반 비율이 유의하게 높았다(75% vs. 25%, P=0.002). 결론: 본 연구에서 상기도 감염의 원인이 바이러스임을 확인된 소아 환자에게서도 항생제를 지속한 주된 이유는 중이염이 동반되었기 때문이었다. 중이염을 정확하게 진단하고 그 중 항생제가 꼭 필요한 경우를 가려낸다면 소아 상기도 감염에서 불필요한 항생제 사용을 줄이는 데 도움이 될 것으로 생각된다.

• 대한한의학방제학회지
• /
• 제16권1호
• /
• pp.79-94
• /
• 2008

Although inflammatory mediators such as nitric oxide(NO) and pro-inflammatory cytokines are involved in host defense mechanism, these overproduction contributes to the pathogenesis of several diseases such as otitis media, hearing loss, periodontitis, bacterial sepsis, rheumatoid arthritis, chronic inflammation and autoimmune diseases. We investigate the anti-inflammatory effects of water extract from Ji-Pae-San(JPSWE) fomulated with Angelica dahurica plus Fritillaria Verticillata, Angelica dahurica(ADWE), and Fritillaria Verticillata(FUVE) in vitro and in vivo. Each extract inhibited the production of inflammatory mediators(NO, $IL-1{\beta}$, IL-6, $TNF-{\alpha}$, and prostaglandin $E_2$) and the expression of inducible NO synthase(iNOS) and cyclooxygenase-2(COX-2) in lipopolysaccharide(LPS)-stimulated RAW 264.7 macrophages in a dose-dependent manner. These inhibitory effects were synergistically increased by their combination. JPSWE also inhibited $TNF-{\alpha}$, $IL-1{\beta}$, IL-6. and $PGE_2$ production as well as COX activity in LPS-stimulated mice. Moreover, JPSWE significantly suppressed death by LPS-septic shock in mice(survival rate: 100%). These results suggest that Ji-Pae-San may be useful for therapeutic drugs against inflammatory immune diseases, probably by suppressing the production of inflammatory mediators.

• Imaging Science in Dentistry
• /
• 제45권2호
• /
• pp.103-108
• /
• 2015

Bony fusion between the mandibular condyle and skull base involves temporomandibular joint (TMJ) bony ankylosis. This condition might originate from trauma, infection, or systemic disease. TMJ adhesion can develop after synovial damage. Both TMJ ankylosis and adhesion lead to functional impairment and pain. Here, we present a case of a 50-year-old female who had bony ankylosis of the right TMJ and adhesion of the left TMJ. She had otitis media in the right ear. A large mass in the right TMJ was observed on computed tomograph. Magnetic resonance image showed a large fused bone mass with normal bone marrow in the right TMJ and flattening of the condyle with a thin disk in the left TMJ. Gap arthroplasty with temporal fascia was performed on the right TMJ, and discectomy, high condylectomy, and coronoidectomy were performed on the left TMJ. During a 2-year follow-up after surgery, the patient had no recurrence.

• 대한임상검사과학회지
• /
• 제40권2호
• /
• pp.135-141
• /
• 2008

Benign paroxysmal positional vertigo (BPPV) is one of the most common clinical entities encountered in a dizziness clinic. Treatment of this disease, canalith repositioning procedures, have been reported to be successful in 44-90%. Treatment requires only one treatment visit in most patients. However, there are significant numbers of patients who require multiple treatment visits for relief. The goal of this study is to identify variables that may be associated with these difficult to treat cases. Retrospective review was performed for the patients diagnosed as BPPV at St. Carollo dizziness center. Variables for statistical analysis included age, sex, involved canal, presence of bilateral disease, presence of recent head trauma, presence of chronic otitis media, history of middle ear surgery, history of otologic surgery, unilateral vestibular loss, underlying disease such as hypertension or diabetes, change of involved canal during treatment course and number of treatment visits. Two hundred patients with BPPV who received treatment were identified from JAN. 2006 to JUN. 2007. 87% required one treatment visit, 5% required second treatment visit, and 95% were successfully treated after three treatment visits. Variables such as bilateral disease, post-traumatic BPPV, duration of symptom before treatment and change of involved canal during treatment were significantly related with number of treatments. Patient's with bilateral BPPV or with recent head trauma or longer duration of symptom are more likely to require multiple visits for canalith repositioning.

• 한국임상수의학회지
• /
• 제25권3호
• /
• pp.176-181
• /
• 2008

Fluid accumulation within the tympanic bulla is an important diagnostic indicator of canine otitis media although its identification can be a challenge using currently available imaging techniques. The purpose of this study was to compare radiography, computed tomography (CT) and magnetic resonance imaging (MRI) in the identification of fluid accumulation within canine tympanic bulla. Unilateral tympanic bulla in 10 beagles were experimentally filled with blood or saline. Quantitative analysis of CT images were obtained by using Hounsfield unit (HU). MR signal intensity was obtained by using region of interesting (ROI) and compared with those of gray matter. On the CT image, the presence of blood or saline produced a fluid opacity occupying the tympanic bulla. On the MR image, the appearance of blood in the tympanic bulla was isointense in T1-weighted images and hyperintense in T2-weighted images. However, the appearance of saline in the tympanic bulla was hypointense in T1-weighted images and hyperintense in T2-weighted images. This study suggest that CT and MR imaging are useful methods for detection and differentiation of fluid in canine tympanic bulla.