• Korean Parent-Child Health Journal
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• v.4 no.1
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• pp.68-81
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• 2001

This research is to study about the weight-change of a pregnant woman, conditions of the woman and an infant. The weight-change of a mother during pregnancy was observed and that was expressed as the basis on the body mass index of a mother before pregnancy. The effects of weight-changes on both the discomfort, complications of pregnant mother and the condition of an infant were also investigated. Thus we set a purpose that this study would help pregnant woman and an infant to maintain and enhance their health conditions by proper weight control through nursing mediation. This study was performed in a certain hospital of university in seoul from Feb. 1. 2000 to Mar. 31. 2000. We explained the purpose of this study to the hospital institution and obtained consent of investigation. 152 inpatients who were in condition from PA 37 weeks to PA 42 weeks were the subject of this study. The research materials were made through of question paper that inpatients make answer by themselves and investigation paper. The question paper was about general background, weight and height before pregnancy and discomfort of the physical degree. And the investigation paper was about parity, maternal weight(late pregnancy), high pregnancy, delivery method, hemoglobin level, Apgar score, fetal weight. Physical discomfort was measured using the implement made by Kim hae won(1996) (chronbach's ${\alpha}=0.85$). SPSS was used to do statistics for managing and analyzing data. The results of this study were like followings. 1. The mean value of gained weight during pregnancy was about 13.8kg within from 3 kg to 26 kg. Among 152 research candidates, the gained weight of 80(52.6%) candidates remained within an ideal range. But that of 37 candidates(24.3%) became less than the ideal range. Also that of 35 candidates(23.0%) became over than the ideal range. 2. In the investigation of the relation between the weight change of a pregnant woman and her condition, the scores to represent physical discomfort were middle in all candidates. And the physical discomfort of over weight-gained group was more than that of low weight-gained group, but there was no difference in statistics(F=0.234, p=0.791). The weight-changes of pregnant woman didn't have an influence with the high risk of pregnancy(F=0.509, p=0.477). Also, the weight-changes didn't have an influence on delivery method($x^2=3.825$, p=0.148). However, in the investigation of the relation between weight-change and hemoglobin level, the change of hemoglobin level was highest in over weight gained group(F=3.062, p=0.05). 3. In the investigation of the weight-change of pregnant woman and the condition of infant. the weight changes didn't have an influence on both 1 min Apgar score(F=0.157, p=0.855) and 5 min Apgar score(F=0.030, p=0.970) of infant. Also, in the investigation of weight-change of a pregnant woman and weight difference of a infant with Pearson Correlation Coefficient, the weight-change of a pregnant woman affected vastly the weight of a infant. It was also found that the more pregnant woman gained in weight, the more did gain weighty infants. This relation was in net proportion(r=0.256, p=0.001). In conclusion, these results suggest that the weight-changes during pregnancy in Korea women of these days are more increased than that of the past days and individual variation in weight-changes is very high. Also, these results suggest that the changed hemoglobin level of a mother and weight of an infant were meaningfully affected by the weight-changes of a pregnant woman during pregnancy. However, the physical discomfort of a pregnant woman, the high risks of pregnancy, the delivery method and Apgar score of an infant were not affected by the weight-changes during pregnancy. Because the recommendation suggesting the ideal weight-change, used this study, is basis on the subject of American women, therefore, these results also suggest the necessity of such recommendation which is subject to Korean women.

• Radiation Oncology Journal
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• v.14 no.4
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• pp.281-290
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• 1996

Purpose : Chest irradiation leads to a significant cardiac injury in a number of patients. To prevent, or to reduce the risk of radiation-induced cardiac injury, pentoxifylline(PTX), a haemorrheologic agent that improves the blood flow through small blood capillaries has been employed. Materials and Methods : One hundred and eighty ICR mice were divided into three study groups: control, radiation alone, and radiation-pentoxifylline. Each group was subdivided into 12 subgroups: 1 3, 6 and 10 days and 2, 3, 4, 6, 8, 12, 16 and 20 weeks by observation Period after irradiation. The total 15Gy of radiation was delivered in a single fraction through anterior mediastinal port. Pentoxifylline was injected subcutaneously daily 50mg/kg to the back of the mice from the first day of irradiation throughout the observation period. The mice of each group after a certain observation period were sacrificed and sectioned for histopathologic examination of the heart. Result : The findings of acute radiation-induced carditis i.e., heterophilic infiltration and vacuolization and ballooning of endothelial cells were observed upto 6 weeks and reduced sharply afterwards. The late radiation effects including pericarditis with mononuclear cell infiltration, pericardial fibrosis, endothelial cell changes, myocardial degeneration and fibrosis present from 4 weeks onwards after irradiation but with various degree of severity. The overall process of pathologic changes of radiation-pentoxifylline group was similar to those of radiation alone group but the duration of acute stage was relatively short and the severity of late cardiac toxicity was much lesser compared with those of radiation alone group. Conclusion : Pentoxifylline can effectively reduce the late radiation-induced cardiac injury and reslve the acute effects relatively rapidly.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.247-254
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• 2007

Purpose : Continuous renal replacement therapy(CRRT) has been the first choice for the treatment of acute renal failure in critically ill children not only in western countries but also in Korea. However, there are very few studies that have analyzed the outcome and prognosis of this modality in Korean children. We performed this study to evaluate the factors associated with the outcome and prognosis of patients treated with CRRT. Methods : We retrospectively reviewed the medical records of 32 children who had received CRRT at Severance hospital from 2003 to 2006. The mean age was 7.5 years(range 4 days-16 years) and the mean body weight was 25.8 kg (range 3.2-63 kg). Results : Eleven(34.4%) of the 32 patients survived. Bone marrow transplantation and malignancy were the most common causes of death and underlying disease leading to the need for CRRT Mean patient weight, age, duration of CRRT, number of organ failures, urine output, estimated glomerular filtration rate(eGFR), C-reactive protein, and blood urea level did not differ significantly between survivors and nonsurvivors. (1) Pediatric risk of mortality(PRISM) III score at CRRT initiation($9.8{\pm}5.3$ vs. $26.7{\pm}7.6$, P<0.0001), (2) maximum pressor number ($2.1{\pm}1.2$ vs. $3.0{\pm}1.0$, P=0.038), and (3) the degree of fluid overload($5.2{\pm}6.0$ vs. $15.0{\pm}8.9$, P=0.002) were significantly lower in survivers than in nonsurvivors. Multivariate analysis revealed that fluid overload was the only independent factor reducing survival rate. Conclusion : CRRT was successfully applied to the treatment of acute renal failure in a wide range of critically ill children. To improve survival, we suggest the early initiation of CRRT to prevent the systemic worsening and progression of fluid overload in critically ill children with acute renal failure. (J Korean Soc Pediatr Nephrol 2007;11:247-254)

• Journal of the Korean Society of Radiology
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• v.11 no.1
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• pp.9-17
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• 2017

A high degree of precision and accuracy in Gamma Knife Radiosurgery(GKRS) is a fundamental requirement for therapeutical success. Elaborate radiation delivery and dose gradients with the steep fall-off of radiation are clinically applied thus necessitating a dedicated Quality Assurance(QA) program in order to guarantee dosimetric and geometric accuracy and reduce all the risk factors that can occur in GKRS. In this study, as a part of QA we verified the accuracy of single-shot dose profiles used in the algorithm of Gamma Knife Perfexion(PFX) treatment planning system employing Variable Ellipsoid Modeling Technique(VEMT). We evaluated the dose distributions of single-shots in a spherical ABC phantom with diameter 160 mm on Gamma Knife PFX. The single-shots were directed to the center of ABC phantom. Collimating configurations of 4, 8, and 16 mm sizes along x, y, and z axes were studied. Gamma Knife PFX treatment planning system being used in GKRS is called Leksell GammaPlan(LGP) ver 10.1.1. From the verification like this, the accuracy of GKRS will be doubled. Then the clinical application must be finally performed based on precision and accuracy of GKRS. Specifically the width at the 50% isodose level, that is, Full-Width-of-Half-Maximum(FWHM) was verified under such conditions that a patient's head is simulated as a sphere with diameter 160mm. All the data about dose profiles along x, y, and z axes predicted through VEMT were excellently consistent with dose profiles from LGP within specifications(${\leq}1mm$ at 50% isodose level) except for a little difference of FWHM and PENUMBRA(isodose level: 20%~80%) along z axis for 4 mm and 8mm collimating configurations. The maximum discrepancy of FWHM was less than 2.3% at all collimating configurations. The maximum discrepancy of PENUMBRA was given for the 8 mm collimator along z axis. The difference of FWHM and PENUMBRA in the dose distributions obtained with VEMT and LGP is too small to give the clinical significance in GKRS. The results of this study are considered as a reference for medical physicists involved in GKRS in the whole world. Therefore we can work to confirm the validity of dose distributions for all collimating configurations determined through the regular preventative maintenance program using the independent verification method VEMT for the results of LGP and clinically assure the perfect treatment for patients of GKRS. Thus the use of VEMT is expected that it will be a part of QA that can verify and operate the system safely.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.559-565
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• 2003

By improving the flow pattern in Fontan circuit, total cavopulmonary connection (TCPC) could result in a better outcome than atriopulmonary connection Fontan operation. For the patients with impaired hemodynamics after atriopulmonary Fontan connection, conversion to TCPC can be expected to bring hemodynamic and functional improvement. We studied the results of the revision of the previous Fontan connection to TCPC in patients with failed Fontan circulation. Material and method: From October1979 to June 2002, eight patients who had failed Fontan circulation, underwent revision of previous Fontan operation to TCPC at Yonsei University Hospital. Intracardiac anomalies of the patients were tricuspid atresia (n=4) and other functional single ventricles (n=4). Mean age at TCPC conversion was 14.0$\pm$7.0 years (range, 4.6~26.2 years) and median interval between initial Fontan operation and TCPC was 7.5 years (range, 2.4~14.3 years). All patients had various degree of symptoms and signs of right heart failure. NYHA functional class was 111 or IV in six patients. Paroxysmal atrial fibrillation (n:f), cyanosis (n=2), intraatrial thrombi (n=2), and protein losing enteropathy (PLE) (n=3) were also combined. The previous Fontan operation was revised to extracardiac conduit placement (n=7) and intraatrial lateral tunnel (n=1). Result: There was no operative death. Major morbidities included deep sternal infection (n=1), prolonged pleural effusion over two weeks (n=1), and temporary junctional lachyarrhythrnia (n=1). Postoperative central venous Pressure was lower than the preoperative value (17.9$\pm$3.5 vs. 14.9$\pm$1.0, p=0.049). Follow-up was complete in all patients and extended to 50,1 months (mean, 30.3$\pm$ 12.8 months). There was no late death. All patients were in NYHA class 1 or 11. Paroxysmal supraventricular tachycardia developed in a patient who underwent conversion to intraatrial lateral tunnel procedure, PLE was recurred in two patients among three patients who had had PLE before the convertsion. There was no newly developed PLE. Conclusion: Hemodynamic and functional improvement could be expected for the patients with Fontan circulatory failure after atriopulmonary connection by revision of their previous circulation to TCPC. The conversion could be performed with low risk of morbidity and mortality.

• Pediatric Infection and Vaccine
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• v.16 no.2
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• pp.162-166
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• 2009

Purpose : Urinary tract infection (UTI) is one of the most common bacterial infectious disease in childhood. Renal scarring is an important complication of UTIs. Known risk factors for renal scarring are younger age, anatomic defects, delayed treatment, and causative pathogens other than Escherichia coli. The aim of this study was to compare the characteristics of clinical and laboratory features of UTI with E. coli to those with non-E. coli in infants. Methods : We reviewed the medical records of 1,120 infants under 12 months of age who had been admitted for UTIs between January 1998 and December 2007. All patients who were diagnosed with UTIs were divided into two groups (E. coli and non-E. coli UTIs). Results : Three hundred twenty-four of 1,120 cases met the inclusion criteria. The number of E. coli and non-E. coli UTIs was 273 (84.3%) and 51 (15.7%), respectively. As compared to the non-E. coli UTI group, the E. coli UTI group was younger (3.59 vs. 4.47 months, P =0.008), a longer duration of pyuria (3.96 vs. 3.06 days, P =0.01), higher peripheral white blood cell counts (13.89 vs. $12.13{\times}10^3/mm^3$, P =0.043), and lower rates of high degree (III-V) vesico-ureteral reflux (P =0.005). Conclusion : UTIs with E. coli might have more severe clinical features and a lower prevalence of high grade vesicoureteral reflux than UTIs with non-E. coli. However, no difference was noted in the clinical response to antibiotic therapy between the two groups.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.321-329
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• 1997

Purpose : It is well known that the risk of lymph nodes metastases to head and neck cancers are influenced by the location and size of the Primary tumor. as well as the degree and types of histological differentiation. However, data on the statistical analyses of lymph node metastases from the head and neck cancers among Korean Population are not available at present. In order to obtain current status of such data, we have analyzed cancer patients at the department of radiation oncology, korea universityhospital for radiation treatment. Materials and Methods : We have evaluated nine-hundred and ninetyseven (997) head and neck cancer Patients who visited to the Department of radiation oncology, between November 1981 to December 1995. After careful physical examinations and CAT scan, Patients were divided into two groups, those with positive lymph node metastases and with negative lymph node metastases. The nodal status were classified according to the TNM system of American Joint Committee on Cancer (AJCC) Besults : Four-hundred and sixteen Patients out of the 997 patients were lymph node positive $(42\%)$ and 581 patients were lymph node negative $(58\%)$ when they were first presented at the department of radiation oncelogy. According to the AJCC classification, the distribution of positive lymph node is as follow: Nl:106 $(25.5\%),\;N2a:100\;(24\%),\;N2b:68\;(16.4\%),\;N2c:69\;(16.6\%),\;3:73\;(15\%).$ respectively. The frequency of lymph node metastases according to the primary sites is as follow : larynx 283 $(28.5\%)$, paranasal sinuses: 182 $(18\%),\;oropharynx:144\;(14.5\%)\;nasopharynx:122(12\%),\;oral\;cavity\;92\;(9\%),\;hypopharynx:71\;(7\%),\;falivary\;gland:58\;(6\%)$ unknown primary:31 $(3\%),\;skin:\;14(2\%)$,. The most frequent Primary site for the positive Iymph node metastases was nasopharynx $(71\%)$ followed by hypopharynx $(69\%),\;oropharynx\;(64\%),\;oral\;cavity\;(39\%)$ The most common histologic type was squamous cell carcinoma (652/997: $65.4\%$). followed by malignant lymphoma $(109/997:11\%)$. Conclusion : Statistical results of lymph node metastases from head and neck cancer at our department were very similar to those obtained from other countries. It is concluded that the location of Primary cancer influences sites of metastases on head and neck, and stage of the primary cancer also influences the development of metastatic lesions. Since the present study is limited on the data collected from one institute. further statistical analyses on Korean cancer Patients are warrented.

• Journal of Life Science
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• v.20 no.11
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• pp.1683-1690
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• 2010

There is an increasing interest in the potential of isoflavone in reducing the risk of cardiovascular disease and cancer, however, although several effects of isoflavone as a component of soy protein are well established, the hypolipidemic and antioxidant effects of purified isoflavone are still controversial. This study was to investigate the effects of isoflavone on serum lipid profiles and antioxidant status in rats. 7-week old male Sprague Dawley rats were fed one of the following diets for 8 weeks: basal diet (B), basal+0.3% isoflavone (BI), basal+0.5% cholesterol (BC), or basal+0.3% isoflavone +0.5% cholesterol (BIC). Two-way ANOVA was used to test the effects of dietary isoflavone and cholesterol supplementation and their interaction on variables. Serum lipid profiles and total antioxidant status (TAS) were examined spectrophotometrically. Degree of serum lipid peroxidation was measured by malondialdehyde (MDA) assay. The activities of serum antioxidant enzymes (GSH-Px, total-SOD) was determined. Levels of serum total cholesterol, VLDL+LDL-cholesterol and Atherogenic index were significantly lower in BI than those levels in group B (p=0.0002, p<0.0001, and p=0.0042, respectively). Serum total antioxidant status (TAS) levels were significantly higher, in both isoflavone supplemented groups (BI, BIC) compared to those levels in each control group (B, BC) (p<0.0001). Activity of total-SOD was significantly higher in BI compared to the activities in group B (p=0.0317). There was no interaction between isoflavone and cholesterol supplementation. In conclusion, isoflavone supplementation showed positive effects on the serum lipid profiles and total antioxidant activities in both conditions, either when fed a diet with or without cholesterol. These effects of isoflavone were independent of cholesterol supplementation.

• Sleep Medicine and Psychophysiology
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• v.3 no.1
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• pp.85-95
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• 1996

Obstructive sleep apnea syndrome(OSAS) in childhood is unique and different n-om that in adulthood in several aspects, including pathophysiology, clinical features, diagnostic criteria, complications, management, and prognosis. Characteristic features of childhood OSAS in comparison with the adult form are the variety of severe complications such as developmental delay, more prominent behavioral and cognitive impairments, vivid cardiovascular symptoms, and increased death risk, warranting a special attention to the possible diagnosis of OSAS in children who snore. However, the childhood OSAS is often neglected and unrecognized. We, therefore, report a case of very severe OSAS in a 5-year-old boy who was sucessfully treated with continuous positive airway pressure(CPAP) treatment. Interestingly, the patient was comor-bid with the attention deficit hyperactivity disorder. Prior to the initial visit to us, adenotonsillectomy had been done at the age of 4 with no significant improvement of apneic symptoms and heavy snoring. On the initial diagnostic procedures, marked degree of snoring was audible even in the daytime wake state and the patient was observed to be very hyperactive. Increased pulmonary vascularity with borderline cardiomegaly was noted on chest X-ray. The baseline polysomnography revealed that the patient was very sleep-apneic and snored very heavily, with the respiratory disturbance index(RDI) of 46.9 per hour of sleep, the mean SaO2 of 78.8%, and the lowest SaO2 of 40.0%(the lowest detectable oxygen level by the applied oxymeter). The second night polysomnography was done for CPAP titration and the optimal pressure turned out to be $8.0\;cmH_2O$. The applied CPAP treatment was well tolerated by the patient and was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. After 18 months of the CPAP treatment, the patient was followed up with nocturnal polysomnography(baseline and CPAP nights) and clinical examination. Sleep apneas were still present without CPAP on the baseline night. However, the severity of OSAS was significantly decreased(RDI of 15.7, mean SaO2 of 96.2%, and the lowest SaO2 of 83.0%), compared to the initial polysomnographic findings before initiation of long-term CPAP treatment. Wechsler intelligence tests done before and after the CPAP treatment were compared with each other and surprising improvement of intelligence(total 9 points, performance 16 points) was noted. Clinically he was found to be markedly improved in his attention deficit hyperactive behavior after CPAP treatment, but with minimal change of TOVA(test of variables of attention) scores except conversion of reaction time score into normal range. On the chest X-ray taken after 18 months of CPAP application, the initial cardiopulmonary abnormalities were not found at all. We found that the CPAP treatment in a young child is very effective, safe, and well-tolerated and also improves the co-morbid attention deficit hyperactive symptoms. Overall, the growth and development of the child has been facilitated with the long-term use of CPAP. Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment. We suggest that early diagnosis and active treatment intervention of OSAS in children are crucial in preventing and ameliorating possible serious complications caused by repetitive sleep apneas and consequent hypoxic damage during sleep.

• Sleep Medicine and Psychophysiology
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• v.11 no.1
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• pp.22-28
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• 2004

Objective: The purpose of this study is to investigate the prevalence rate of OSA in subjects whose main sleep complaint is insomnia and to find differential factors of OSA in these insomniac subjects. Method: We reviewed the medical records and polysomnographic findings of patients referred to the Sleep Laboratory at Seoul National University Hospital from January 1996 to December 2002. Four-hundred and seventy subjects complained of insomnia as their main sleep problem (235 males and 235 females, mean age $53.6{\pm}12.4\;years$). First, we investigated the prevalence rate of OSA in these insomniac patients. Second, we compared the clinical and demographic characteristics of the OSA-associated group with those of the non-associated group. Third, we examined whether the degree or presence of differential factors within the OSA group correlate with severity of OSA, as determined by the respiratory disturbance index (RDI). Results: Among 470 insomniac subjects, 125 subjects (26.6%) were diagnosed as OSA by nocturnal polysomnography. OSA-associated subjects were significantly older ($58.4{\pm}12.3\;years$ vs. $51.8{\pm}11.2\;years$, p<0.01), and had significantly higher body mass index (BMI) ($23.4{\pm}3.3\;kg/m^2$ vs. $22.5{\pm}3.1\;kg/m^2$, p=0.44) than non-associated subjects. The OSA-associated group had more subjects with male gender (64.0% vs. 44.9%, p<0.01), hypertension (20.0% vs. 9.3%, p<0.01) or snoring (96.0% vs. 63.5%, p<0.01). Within the OSA-associated group, age had a significant positive correlation with RDI (p=0.01). Conclusion: We found that a considerable portion of patients complaining of insomnia as their main sleep problem were diagnosed as OSA. Snoring, old age, male gender, obesity, and comorbid hypertension were found to be differential factors of OSA in insomniac patients. We suggest that diagnostic efforts including nocturnal polysomnography are needed for insomniac patients with any of the above risk factors of OSA.