• Korean Journal of Cleft Lip And Palate
• /
• v.7 no.1
• /
• pp.17-24
• /
• 2004

Cleft lip and palate are most common congenital defomity to affect the orofacial region. Cleft lip and palate are caused by abnormal development of primary and secondary palate. Its causative mechanism is not completely understood, but genetic and environmental factors play important roles. Lots of epidemiologic surveys have been done extensively about incidence, racial influence, sex ratio, parent age, associated syndrome and genetic factors. These researches are useful to dissolve many problems in prevention and treatment of cleft lip and palate. We performed epidemiologic survey of cleft lip and palate who visited the department of Oral and Maxillofacial Surgery, Guro hospital of Korea University from 1995 to 2004.

• Journal of Korean Medical classics
• /
• v.19 no.4
• /
• pp.182-192
• /
• 2006

통과대복의육십사괘차서도(通過對伏義六十四卦次序圖), 방도(方圖), 원도적연구(圓圖的硏究), 이급장개빈대육십사괘방원도중소천발적의역학내용적연구(以及張介賓對六十四卦方圓圖中所闡發的醫易學內容的硏究), 득출여하결론(得出如下結論): 1. 육십사괘적생성원리중(六十四卦的生成原理中), 존재소강절적일분위이법설화번사전적일정팔회설(存在邵康節的一分爲二法設和繁辭傳的一貞八悔說), 이사지횡향배열적도(而使之橫向排列的圖), 칭위복의육십사괘차서원(대횡도)(稱爲伏義六十四卦次序圓(大橫圖)). 종차원(從此圓), 가청초지효육십사괘적생성근원(可淸楚知曉六十四卦的生成根源). 2. 복의육십사괘원도(伏義六十四卦圓圖), 파대횡도분위료양부분(把大橫圖分爲了兩部分), 즉전삼십이괘종좌상방향하진행료배치(卽前三十二卦從左上方向下進行了配置), 이후삼십이괘종우상방향하원형진행료배치(而後三十二卦從右上方向下圓形進行了配置). 차원이자오묘유위중심청초지현시출료양시(자)(此圓以子午卯酉爲中心淸楚地顯示出了陽始(子)), 양진(묘)(陽辰(卯)), 양극(오)(陽極(午)). 음시(오)(陰始(午)), 음진(유)(陰辰(酉)), 음극(자)등적상(陰極(子)等的象), 체현료천도순환적도리(體現了天道循環的道理). 3. 복의육십사괘방원(伏義六十四卦方圓), 야유래어대횡도(也由來於大橫圖), 역체현료지도원리급선천법상적자연지묘(亦體現了地道原理及先天法象的自然之妙). 4. 복의육십사괘방위원시근거천지지리(伏義六十四卦方位圓是根據天地之理), 재복의육십사괘원도내배치료복의육십사괘방원(在伏義六十四卦圓圖內配置了伏義六十四卦方圓). 저시유주자수차배치적(這是由朱子首次配置的). 원도이원형진행료배치(圓圖以圓形進行了配置), 중공상태체현료천지순환적질서(中空狀態體現了天之循環的秩序), 이방도이방형진행료배치(而方圖以方形進行了配置), 중간충실체현료지지존재적상태(中間充實體現了地之存在的狀態), 기작용균시어중심부(基作用均始於中心部). 방원도중포함착일개월적변화(方圓圖中包含着一個月的變化), 일년적운행(一年的運行), 129,600년지우주일년적변화(年之宇宙一年的變化), 천지적종시(天地的終始), 인물적생사(人物的生死), 고금세변적원리등(古今世變的原理等). 5. 장개빈확립료용역학원리해석의학적의역학(張介貧確立了用易學原理解釋醫學的醫易學), 파육십사괘방원여인체진행결합작료천발(把六十四卦方圓與人體進行結合作了闡發). 기일(基一), 기인위육십사괘원도적중심시태극(基認爲六十四卦圓圖的中心是太極), 차부상당어인체지심, 이건남곤북화리동감서(而乾南坤北和離東坎西), 분별대응어상수하복화좌우이목(分別對應於上首下腹和左右耳目). 기이(基二), 원도이사등분적사상(圓圖以四等分的四象), 파인생분위료사분(把人生分爲了四分), 병분별진행료배속(幷分別進行了配屬). 저설명료파육십사괘여 "소문·상고천진론" 중이팔수위변적장부원리(這設明了把六十四卦與『素問·上古天眞論』中以八수爲變的丈夫原理), 소진행적배속관계(所進行的配屬關係). 기삼(基三), 기인위재원도중(基認爲在圓圖中), 여동양시생적복괘(천근)여음시생적구괘(월굴), 相互交替進行循環一樣, 인적생장쇠로적도리화일일중오매적도리시일양적(人的生長衰老的道理和一日中寤寐的道理是一樣的). 기사(基四), 기재원도중(基在圓圖中), 이천양재남화천부족서북(以天陽在南和天不足西北), 래설명료건재남화곤재북적도리(來說明了乾在南和坤在北的道理), 병재방토중이지강재북화지불만동남(幷在方土中以地剛在北和地不滿東南), 래설명료건재서북화건재동남적도리, 이육십사괘적원리여의학밀접결합, 대지진행료설명(對之進行了說明).

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.12 no.1
• /
• pp.16-22
• /
• 2009

Purpose: To update the epidemiologic information of hepatobiliary diseases in pediatric inpatients using cross-sectional survey data throughout the Republic of Korea. Methods: Nationwide cross-sectional survey was obtained from the 85 residency training hospitals in Korea to gather the final diagnosis on discharge. The surveyed periods were from 2004 to 2006. All the reports regarding the diagnosis were based on ICD-10 system. In this study, we focused on hepatobiliary diseases. Results: A total of 826,896 cases with discharge data were collected, of which 4,151 (5.0%) hepatobiliary cases were identified; 2,385 cases (57.4%) of hepatobiliary disease were hepatitis, which was the most common hepatobiliary disease. Other diseases included congenital hepatobiliary diseases (524 cases [12.6%]) and biliary diseases (315 cases [7.6%]). The prevalence of hepatobiliary disease according to age differed. Biliary atresia was the most common hepatobiliary disease in the neonatal period, whereas the prevalence of hepatitis increased in adolescents. The total number of hepatobiliary operations was 416 cases. With the comparison of annual data, there was no definite difference in the total number of hepatobiliary cases. The average duration of hospital stay appeared to decrease gradually. Conclusion: In this study, we have summarized the recent epidemiology of hepatobiliary disorders in Korean children based on discharge data. Hepatobiliary disorders in pediatric inpatient units consisted of diverse disorders with a low prevalence, so multi-center approaches should be considered to enhance the clinical and public health outcomes. To improve this nationwide survey, a new data collecting system should be developed.

• Journal of Chest Surgery
• /
• v.38 no.4 s.249
• /
• pp.277-283
• /
• 2005

Arterial oxygen saturation $(SaO_2)$ instability frequently takes place after systemic-pulmonary shunt without shunt occlusion. We analyzed actual incidence and risk factors for $SaO_2$ instability after shunt operations, and possible mechanisms were speculated on. Material and Method: Ninety three patients, who underwent modified Blalock-Taussig shunt from January 1996 to December 2000, were enrolled in this study. Adequacy of shunt was verified in all patients, either by ensuing one ventricle or biventricular repair later on or by appropriate pulmonary artery growth on postoperative angiogram. Age, body weight, hemoglobin level at operation were 3 day to 36 years (median: 1.8 months), 2.5kg to 51kg (median: 4.1kg) and $10.7\~24.3$ gm/dL (median: 15.2 gm/dL) respectively. Preoperative diagnoses were functional single ventricle with pulmonary stenosis or atresia in 39, tetralogy of Fallot in 38 and pulmonary atresia with intact ventricular septum in 16. Pulmonary blood flow (PBF) was maintained pre-operatively by patent ductus or previous shunt in 64 and by forward flow through stenotic right ventricular outflow tract (RVOT) in 29. $SaO_2$ instability was defined as $SaO_2$ less than $50\%$ for more than 1 hour with neither anatomic obstruction of shunt nor respiratory problem. Result: 10 patients $(10.7\%)$ showed $SaO_2$ instability after shunt operation. After shunt occlusion was ruled out by echocardiogram, they received measures to lower pulmonary vascular resistance (PVR), which worked within a few hours in all patients. Risk factors for $SaO_2$ instability included older age at operation (p=0.039), lower preoperative $SaO_2$ (p=0.0001) and emergency operation (p=0.001). PBF through stenotic RVOT showed marginal statistical significance (p=0.065). Conclusion: $SaO_2$ instability occurs frequently after shunt operation, especially in patients with severe hypoxia pre-operatively or unstable clinical condition necessitating emergency operation. Temporary elevation of pulmonary vascular resistance is a possible mechanism in this specific clinical setting.

• Journal of Chest Surgery
• /
• v.35 no.8
• /
• pp.580-583
• /
• 2002

Background: Obtaining precise hemodynamic and morphological information in the early postoperative period after surgical correction of congenital heart disease is important in determining the need for future medical or surgical intervention. We investigated the residual shunting after surgical repair of simple ventricular septal defect in order to know the incidence of residual shunting in the postoperative period and the natural history of small residual shunts located in the peripatch area. Material and Method: Forty three consecutive patients under one year of age who underwent patch repair of a simple ventricular septal defect were evaluated for incidence of residual shunts by echocardiography. Result: Eleven patients had echocardiographic residual shunt in the peripatch area at immediate postoperative period, however, there were no patients who needed reoperation due to deteriorated hemodynamic effect of residual shunt. The incidence of residual shunts was not significantly different with type of ventricular septal defect and material used for closure. During follow up period, two patients were lost and remaining nine patients no longer showed evidence of residual shunt. The mean time of last evidence of shunt was $4.2{\pm}3.6$ months after operation. Conclusion: Residual peripatch shunt flow was frequently noted in the immediate postoperative period following surgical repair of ventricular septal defect, however, most of them were disappeared within six months.

• Journal of Chest Surgery
• /
• v.42 no.1
• /
• pp.87-91
• /
• 2009

The surgical management of complete transposition of the great arteries, ventricular septal defect, and pulmonary stenosis still remain a significant challenge. The Rastelli (REV procedure) remains the most widely applied procedure for surgical repair of these lesions. Although the Rastelli procedure can be performed with good early results, the intermediate- and long-term results have been less than satisfactory because of deterioration of the hemodynamic performance of the LVOT or RVOT. We performed a modified Nikaidoh procedure as an alternative surgical procedure in a 19-month-old boy weighing 10.4 kg with this anomaly. Aortic translocation with biventricular outflow tract reconstruction resulted in a more "normal" anatomic repair and postoperative echocardiography showed straight, direct, and unobstructed ventricular outflow.

• Journal of Chest Surgery
• /
• v.31 no.12
• /
• pp.1226-1229
• /
• 1998

50 days old, 4.5kg male patient was admitted at department of pediatrics due to congenital heart disease with congestive heart failure. The echocardiographic finding was perimembranous type ventricular septal defect. The patient underwent open heart surgery for patch closure of VSD. Immediately postoperatively, junctional ectopic tachycardia developed and the patient was in hemodynamically unstable state with decreased urine output. We used inotropics, digitalis and diuretics, however these treatments were not effective in recovering the unstable state. Therefore, we tried a mild hypothermic treatment(34℃). During the POD #2, mild hypothermia method was repeated four times. The junctional ectopic tachycardia was converted to normal sinus rhythm, hemodynamic state was stable, and urine output was increased. The patient was discharged at POD #8.

• Journal of Dental Rehabilitation and Applied Science
• /
• v.26 no.1
• /
• pp.77-87
• /
• 2010

Skeletodental asymmetries are common and asymmetric orthodontic treatments are very difficult to correct successfully. The cause of asymmetries can be the skeletal asymmetry, dental, or functional, or combinations of these causes. Skeletodental asymmetries can be the result of congenital factors, such as hemifacial microsomia and environmental factors, such as trauma. Optimal treatment outcome of the severe facial asymmetry requires the orthognathic surgery. Mild asymmetry problem can be treated by only orthodontic treatment. The orthodontic treatment of asymmetry is usually difficult. Facial asymmetry orthodontic treatment are primarily based on proper diagnosis and careful treatment planning. Side effects of asymmetric elastic to treat midline discrepancies are canted occlusal plane, tipped incisors and unesthetic results. In the management of dental arch asymmetries, the clinician should select the appropriate force system and the appliance design necessary to address the asymmetry while minimizing undesirable side effects. This report presents treatment strategies for the treatment of skeletodental asymmetry. In this case report, the clinical case with midline discrepancies treated by optimal mechanics is described. Through diagnosis and strategic treatment mechanics can obtain proper midline correction with minimal side effects.

• Clinical and Experimental Pediatrics
• /
• v.45 no.9
• /
• pp.1065-1074
• /
• 2002

Purpose : The purpose of this study is to analyze the epidemiologic characteristics of sudden unexpected death in infancy and to evaluate the importance of postmortem autopsy. Methods : We reviewed, retrospectively, medical records of 34 infants admitted to Kangnam General Hospital from January 1987 to December 2001 because of sudden unexpected death. We investigated the cause of death through medical history, death scene examination, autopsy findings, acylcarnitine and organic acid analysis. Results : Among the total 34 infants, 18 were male(52.9%) and 16 were female(47.1%). Thirty infants(88%) were below the six months of age. Winter was the most affected season(38.2%). Eighteen infants(52.9%) died between 6 and 12AM. The prone sleeping position was observed more frequently than the supine position at death; nine cases in the prone position, six cases in the supine position. The cause of death of 23 cases could not be found by only history and death scene examination. Autopsy was done in 13 cases. Seven cases of them were thought to be SIDS. In six cases, we explained the cause of death with autosy findings. They were an endocardial fibroelastosis, a nesidioblastosis, a subdural hematoma, a bronchopneumonia and two fatty changes of liver. Metabolic screening tests performed in three cases to rule out metabolic disorder since 2000 were all normal. Conclusion : We concluded that autopsy and metabolic screening test should be performed to find out the cause of death in sudden unexpected death in infancy.

• Journal of Chest Surgery
• /
• v.31 no.5
• /
• pp.472-480
• /
• 1998

We reviewed the surgical results of intracardiac lateral tunnel Fontan procedure for the repair of functional single ventricles. Between 1990 and 1996, 104 patients underwent total cavopulmonary anastomosis. Patients' age and body weight averaged 35.9(range 10 to 173) months and 12.8(range 6.5 to 37.8) kg. Preoperative diagnoses included 18 tricuspid atresias and 53 double inlet ventricles with univentricular atrioventricular connection and 33 other complex lesions. Previous palliative operations were performed in 50 of these patients, including 37 systemic to pulmonary artery shunts, 13 pulmonary artery bandings, 15 surgical atrial septectomies, 2 arterial switch procedures, 2 resections of subaortic conus, 2 repairs of total anomalous pulmonary venous connection and 1 Damus-Stansel-Kaye procedure. In 19 patients bidirectional cavopulmonary shunt operation was performed before the Fontan procedure and in 1 patient a Kawashima procedure was required. Preoperative hemodynamics revealed a mean pulmonary artery pressure of 14.6(range 5 to 28) mmHg, a mean pulmonary vascular resistance of 2.2(range 0.4 to 6.9) wood-unit, a mean pulmonary to systemic flow ratio of 0.9(range 0.3 to 3.0), a mean ventricular end-diastolic pressure of 9.0 (range 3.0 to 21.0) mmHg, and a mean arterial oxygen saturation of 76.0(range 45.6 to 88.0)%. The operative procedure consisted of a longitudinal right atriotomy 2cm lateral to the terminal crest up to the right atrial auricle, followed by the creation of a lateral tunnel connecting the orifices of either the superior caval vein or the right atrial auricle to the inferior caval vein, using a Gore-Tex vascular graft with or without a fenestration. Concomitant procedures at the time of Fontan procedure included 22 pulmonary artery angioplasties, 21 atrial septectomies, 4 atrioventricular valve replacements or repairs, 4 corrections of anomalous pulmonary venous connection, and 3 permanent pacemaker implantations. In 31, a fenestration was created, and in 1 an adjustable communication was made in the lateral tunnel pathway. One lateral tunnel conversion was performed in a patient with recurrent intractable tachyarrhythmia 4 years after the initial atriopulmonary connection. Post-extubation hemodynamic data revealed a mean pulmonary artery pressure of 12.7(range 8 to 21) mmHg, a mean ventricular end-diastolic pressure of 7.6(range 4 to 12) mmHg, and a mean room-air arterial oxygen saturation of 89.9(range 68 to 100) %. The follow-up duration was, on average, 27(range 1 to 85) months. Post-Fontan complications included 11 prolonged pleural effusions, 8 arrhythmias, 9 chylothoraces, 5 of damage to the central nervous system, 5 infectious complications, and 4 of acute renal failure. Seven early(6.7%) and 5 late(4.8%) deaths occured. These results proved that the lateral tunnel Fontan procedure provided excellent hemodynamic improvements with acceptable mortality and morbidity for hearts with various types of functional single ventricle.