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Legal Study for the KSLV launching - Products & Third Party Liability - (KSLV발사에 따른 제작 및 제3자피해 책임에 대한 우주법적 소고)

  • Shin, Sung-Hwan
    • The Korean Journal of Air & Space Law and Policy
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    • v.21 no.1
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    • pp.169-189
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    • 2006
  • In 2007, KSLV(Korea Small Launching Vehicle) that we made at Goheung National Space Center is going to launch and promotes of our space exploration systematically and 'Space Exploration Promotion Act' was enter into force. 'Space Exploration Promotion Act' article 3, section 1, as is prescribing "Korean government keeps the space treaties contracted with other countries and international organizations and pursues after peaceful uses of outer space." The representative international treaties are Outer Space Treaty (1967) and Liability Convention (1972) etc. In Liability convention article 2, "A launching State shall be absolutely liable to pay compensation for damage caused by its space object on the surface of the earth or to aircraft in flight. The important content of the art. 2 is the responsible entity is the 'State' not the 'Company'. According by Korean Space Exploration Act art. 14, person who launches space objects according to art. 8 and art. 11 must bear the liability for damages owing to space accidents of the space objects. Could Korean government apply the Products Liability Act which is enter into force from July 1, 2002 to space launching person? And what is the contact type between Korea Aerospace Research Institute(KARl) and Russia manufacturer. Is that a Co-Development contract or Licence Product contract? And there is no exemption clause to waive the Russia manufacturer's liability which we could find it from other similar contract condition. If there is no exemption clause to the Russia manufacturer, could we apply the Korean Products Liability Act to Russia one? The most important legal point is whether we could apply the Korean Products Liability Act to the main component company. According by the art. 17 of the contract between KARl and the company, KARl already apply the Products Liability Act to the main component company. For reference, we need to examine the Appalachian Insurance co. v. McDonnell Douglas case, this case is that long distance electricity communication satellite of Western Union Telegraph company possessions fails on track entry. In Western Union's insurance company supplied to Western Union with insurance of $ 105 millions, which has the satellite regard as entirely damage. Five insurance companies -Appalachian insurance company, Commonwealth insurance company, Industrial Indemnity, Mutual Marine Office, Northbrook Excess & Surplus insurance company- went to court against McDonnell Douglases, Morton Thiokol and Hitco company to inquire for fault and strict liability of product. By the Appalachian Insurance co. v. McDonnell Douglas case, KARl should waiver the main component's product liability burden. And we could study the possibility of the adapt 'Government Contractor Defense' theory to the main component company.

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A Study on Aviation Safety and Third Country Operator of EU Regulation in light of the Convention on international Civil Aviation (시카고협약체계에서의 EU의 항공법규체계 연구 - TCO 규정을 중심으로 -)

  • Lee, Koo-Hee
    • The Korean Journal of Air & Space Law and Policy
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    • v.29 no.1
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    • pp.67-95
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    • 2014
  • Some Contracting States of the Chicago Convention issue FAOC(Foreign Air Operator Certificate) and conduct various safety assessments for the safety of the foreign operators which operate to their state. These FAOC and safety audits on the foreign operators are being expanded to other parts of the world. While this trend is the strengthening measure of aviation safety resulting in the reduction of aircraft accident. FAOC also burdens the other contracting States to the Chicago Convention due to additional requirements and late permission. EASA(European Aviation Safety Agency) is a body governed by European Basic Regulation. EASA was set up in 2003 and conduct specific regulatory and executive tasks in the field of civil aviation safety and environmental protection. EASA's mission is to promote the highest common standards of safety and environmental protection in civil aviation. The task of the EASA has been expanded from airworthiness to air operations and currently includes the rulemaking and standardization of airworthiness, air crew, air operations, TCO, ATM/ANS safety oversight, aerodromes, etc. According to Implementing Rule, Commission Regulation(EU) No 452/2014, EASA has the mandate to issue safety authorizations to commercial air carriers from outside the EU as from 26 May 2014. Third country operators (TCO) flying to any of the 28 EU Member States and/or to 4 EFTA States (Iceland, Norway, Liechtenstein, Switzerland) must apply to EASA for a so called TCO authorization. EASA will only take over the safety-related part of foreign operator assessment. Operating permits will continue to be issued by the national authorities. A 30-month transition period ensures smooth implementation without interrupting international air operations of foreign air carriers to the EU/EASA. Operators who are currently flying to Europe can continue to do so, but must submit an application for a TCO authorization before 26 November 2014. After the transition period, which lasts until 26 November 2016, a valid TCO authorization will be a mandatory prerequisite, in the absence of which an operating permit cannot be issued by a Member State. The European TCO authorization regime does not differentiate between scheduled and non-scheduled commercial air transport operations in principle. All TCO with commercial air transport need to apply for a TCO authorization. Operators with a potential need of operating to the EU at some time in the near future are advised to apply for a TCO authorization in due course, even when the date of operations is unknown. For all the issue mentioned above, I have studied the function of EASA and EU Regulation including TCO Implementing Rule newly introduced, and suggested some proposals. I hope that this paper is 1) to help preparation of TCO authorization, 2) to help understanding about the international issue, 3) to help the improvement of korean aviation regulations and government organizations, 4) to help compliance with international standards and to contribute to the promotion of aviation safety, in addition.

Mineralogy and Geochemistry of the Jeonheung and Oksan Pb-Zn-Cu Deposits, Euiseong Area (의성(義城)지역 전흥(田興) 및 옥산(玉山) 열수(熱水) 연(鉛)-아연(亞鉛)-동(銅) 광상(鑛床)에 관한 광물학적(鑛物學的)·지화학적(地化學的) 연구(硏究))

  • Choi, Seon-Gyu;Lee, Jae-Ho;Yun, Seong-Taek;So, Chil-Sup
    • Economic and Environmental Geology
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    • v.25 no.4
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    • pp.417-433
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    • 1992
  • Lead-zinc-copper deposits of the Jeonheung and the Oksan mines around Euiseong area occur as hydrothermal quartz and calcite veins that crosscut Cretaceous sedimentary rocks of the Gyeongsang Basin. The mineralization occurred in three distinct stages (I, II, and III): (I) quartz-sulfides-sulfosalts-hematite mineralization stage; (II) barren quartz-fluorite stage; and (III) barren calcite stage. Stage I ore minerals comprise pyrite, chalcopyrite, sphalerite, galena and Pb-Ag-Bi-Sb sulfosalts. Mineralogies of the two mines are different, and arsenopyrite, pyrrhotite, tetrahedrite and iron-rich (up to 21 mole % FeS) sphalerite are restricted to the Oksan mine. A K-Ar radiometric dating for sericite indicates that the Pb-Zn-Cu deposits of the Euiseong area were formed during late Cretaceous age ($62.3{\pm}2.8Ma$), likely associated with a subvolcanic activity related to the volcanic complex in the nearby Geumseongsan Caldera and the ubiquitous felsite dykes. Stage I mineralization occurred at temperatures between > $380^{\circ}C$ and $240^{\circ}C$ from fluids with salinities between 6.3 and 0.7 equiv. wt. % NaCl. The chalcopyrite deposition occurred mostly at higher temperatures of > $300^{\circ}C$. Fluid inclusion data indicate that the Pb-Zn-Cu ore mineralization resulted from a complex history of boiling, cooling and dilution of ore fluids. The mineralization at Jeonheung resulted mainly from cooling and dilution by an influx of cooler meteoric waters, whereas the mineralization at Oksan was largely due to fluid boiling. Evidence of fluid boiling suggests that pressures decreased from about 210 bars to 80 bars. This corresponds to a depth of about 900 m in a hydrothermal system that changed from lithostatic (closed) toward hydrostatic (open) conditions. Sulfur isotope compositions of sulfide minerals (${\delta}^{34}S=2.9{\sim}9.6$ per mil) indicate that the ${\delta}^{34}S_{{\Sigma}S}$ value of ore fluids was ${\approx}8.6$ per mil. This ${\delta}^{34}S_{{\Sigma}S}$ value is likely consistent with an igneous sulfur mixed with sulfates (?) in surrounding sedimentary rocks. Measured and calculated hydrogen and oxygen isotope values of ore-forming fluids suggest meteoric water dominance, approaching unexchanged meteoric water values. Equilibrium thermodynamic interpretation indicates that the temperature versus $fs_2$ variation of stage I ore fluids differed between the two mines as follows: the $fs_2$ of ore fluids at Jeonheung changed with decreasing temperature constantly near the pyrite-hematite-magnetite sulfidation curve, whereas those at Oksan changed from the pyrite-pyrrhotite sulfidation state towards the pyrite-hematite-magnetite state. The shift in minerals precipitated during stage I also reflects a concomitant $fo_2$ increase, probably due to mixing of ore fluids with cooler, more oxidizing meteoric waters. Thermodynamic consideration of copper solubility suggests that the ore-forming fluids cooled through boiling at Oksan and mixing with less-evolved meteoric waters at Jeonheung, and that this cooling was the main cause of copper deposition through destabilization of copper chloride complexes.

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Studies on Epidemiological Survey of Infectious Disease of Chicken in Korea (국내 닭 전염성 질병에 관한 역학적 조사 연구)

  • 이용호;박근식;오세정
    • Korean Journal of Poultry Science
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    • v.16 no.3
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    • pp.175-192
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    • 1989
  • A total of 9, 012 cases was submitted for diagnosis of chicken diseases to Veterinary Research Institute, Rural Development Administration from domestic chicken farms during 18 years from 1971 to 1988. Of them, 6, 181 cases diagnosed as the infectious disease were investigated for the detection rate of infections on basis of you, season , and chicken age. The results obtained were summarized as followings:1. Detection rate or the infections was lowest as 49.3% in the year 1973, and highest as 78.6% in 1985 (average 68.6%). 2. Of infections detected, bacterial diseases were most frequent (32.6%), and followed in order by viral (26.3%), parasitic (7.7%), and fungal diseases (2.1%) in geneal. 3. The most frequently detected bacterial diseases in order of prevalence were mycoplasmosis (8.8%), colibacillosis (8.5%), and staphylococcosis (5.8%), and followed by salmonellosis pullorum disease , yolk sac disease, and salpingitis (0.8-1.5%). 4. In viral diseases, 7.5% of infections detected was lymphoid leukosis and 7.2%-Marek's disease, 4.4%-Newcastle disease, 2.0%-infectious laryngotracheitis, 1.7%-infectious bursal disease, and 1.0%-avian encephalomyelitis, while detection rate of infectious bronchitis, egg drop syndrome '76, and inclusion body hepatitis was less than 1.0%, respectively. 5. The most prevalent parasitic disease was coccidiosis (4.5%), followed by ascariasis (1.4%). The detection rate of other parasitic diseases including leucocytozoonosis, black head , heterakiasis, and ectoparasitosis was very as 0.2-0.7%, respectively: In fungal diseases, 2.0% of infections was detected as aspergillosis, and followed by candidiasis (0.1%). 6. Detection rate of the infections on basis of season was somewhat higher in summer. (27.7%), and autumn (27.7%) than in winter (23.5%), and spring (21.5%) in general. In bacterial, viral, and fungal diseases, there were the similar tendencies of detection rate as in infections, while parasitic diseases were much highly detected in summer (34.3%), and autumn (39.5%) than in any other season. 7. Among bacterial diseases colibacillosis was most frequently detected in summer, and staphylococcosis in autumn. In detection rate of viral diseases, Marek's disease, infectious laryngotracheitis, and infectious bursal disease was highest in summer, lymphold leukosis, fowl pox and egg drop syndrome '76 in autumn, and infectious trachitis in winter, repectively. The majority of important parasitic diseases including coccidiosis were highly detected in summer and autumn. 8. On basis of chicken age, detection rate of infections were highest in chicken of growing period between 30 and 150 days of age (41.4%), and followed by 35.3% in laying chicken over 150 days of age, and 17.3% in chicken of brooding age under 30 days of age. Bacterial, and parasitic diseases were most frequently detected in chicken of growing period, viral diseases in chicken of growing, and laying period as nearly equal rate of detection, and fungal diseases in chicken of brooding age.

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Investigation of Poultry Farm for Productivity and Health in Korea (한국에 있어서 양계장의 실태와 닭의 생산성에 관한 조사(위생과 질병중심으로))

  • 박근식;김순재;오세정
    • Korean Journal of Poultry Science
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    • v.7 no.2
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    • pp.54-76
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    • 1980
  • A survey was conducted to determine the status of health and productivity of poultry farms in Korea. Area included Was Kyunggido where exist nearly 50% of national poultry population. From this area, 41 layer and 34 broiler farms covering 21 Countries were selected randomly for the survey. When farms were divided in the operation size, 95.1% of layer and 82.3% of broiler farms were classified as business or industrial level while the rest were managed in a small scale as part time job. Generally layer farms had been established much earlier than broiler farms. Geographically 10.7% of layer farms were sited near the housing area such as field foreast and rice field. No farms were located near the seashore. The distance from one farm from the other was very close, being 80% of the farms within the distance of 1km and as many as 28% of the farms within loom. This concentrated poultry farming in a certain area created serious problems for the sanitation and preventive measures, especially in case of outbreak of infectious diseases. Average farm size was 5,016${\times}$3.3㎡ for layers and 1,037${\times}$3.3㎡ for broilers. 89.5% of layer ana 70.6% of broiler farms owned the land for farming while the rest were on lease. In 60% of layer farms welters were employed for farming while in the rest their own labour was used. Majority of farms were equipped poorly for taking necessary practice of hygiene and sanitation. The amount of disinfectant used by farms was considerably low. As many as 97.6% of lave. farms were practised with Newcastle(ND) and fowl pox(F$.$pox) vaccine, whereas only 43.6% and 5.1% of broiler farms were practised with ND and F$.$pox vaccine, respectively. In 17-32.7% of farms ND vaccine was used less than twice until 60 days of age and in only 14.6% of farms adult birds were vaccinated every 4months. Monthly expense for preventive measures was over 200,000W in 32% of farms. Only 4.9-2.7% of vaccine users were soaking advice from veterinarians before practising vaccination, 85% of the users trusted the efficacy of the vaccines. Selection of medicine was generally determined by the farm owner rather than by veterinarans on whom 33.3% of farms were dependant. When diseases outbroke, 49.3% of farms called for veterinary hospital and the rest were handled by their own veterinarians, salesmen or professionals. Approximately 70% of farms were satisfied with the diagnosis made by the veterinarians. Frequency of disease outbreaks varied according to the age and type of birds. The livabilities of layers during the period of brooding, rearing ana adultwere 90.5, 98.9 and 75.2%, respectively while the livalibility of broilers until marketing was 92.2%. In layers, average culling age, was 533.3 day and hen housed eggs were 232.7. Average feed conversion rates of layers and broilers were 3.30 and 2.48, respectively. Those figures were considerably higher than anticipated but still far lower than those in developed countries.

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Quality Assurance for Intensity Modulated Radiation Therapy (세기조절방사선치료(Intensity Modulated Radiation Therapy; IMRT)의 정도보증(Quality Assurance))

  • Cho Byung Chul;Park Suk Won;Oh Do Hoon;Bae Hoonsik
    • Radiation Oncology Journal
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    • v.19 no.3
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    • pp.275-286
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    • 2001
  • Purpose : To setup procedures of quality assurance (OA) for implementing intensity modulated radiation therapy (IMRT) clinically, report OA procedures peformed for one patient with prostate cancer. Materials and methods : $P^3IMRT$ (ADAC) and linear accelerator (Siemens) with multileaf collimator are used to implement IMRT. At first, the positional accuracy, reproducibility of MLC, and leaf transmission factor were evaluated. RTP commissioning was peformed again to consider small field effect. After RTP recommissioning, a test plan of a C-shaped PTV was made using 9 intensity modulated beams, and the calculated isocenter dose was compared with the measured one in solid water phantom. As a patient-specific IMRT QA, one patient with prostate cancer was planned using 6 beams of total 74 segmented fields. The same beams were used to recalculate dose in a solid water phantom. Dose of these beams were measured with a 0.015 cc micro-ionization chamber, a diode detector, films, and an array detector and compared with calculated one. Results : The positioning accuracy of MLC was about 1 mm, and the reproducibility was around 0.5 mm. For leaf transmission factor for 10 MV photon beams, interleaf leakage was measured $1.9\%$ and midleaf leakage $0.9\%$ relative to $10\times\;cm^2$ open filed. Penumbra measured with film, diode detector, microionization chamber, and conventional 0.125 cc chamber showed that $80\~20\%$ penumbra width measured with a 0.125 cc chamber was 2 mm larger than that of film, which means a 0.125 cc ionization chamber was unacceptable for measuring small field such like 0.5 cm beamlet. After RTP recommissioning, the discrepancy between the measured and calculated dose profile for a small field of $1\times1\;cm^2$ size was less than $2\%$. The isocenter dose of the test plan of C-shaped PTV was measured two times with micro-ionization chamber in solid phantom showed that the errors upto $12\%$ for individual beam, but total dose delivered were agreed with the calculated within $2\%$. The transverse dose distribution measured with EC-L film was agreed with the calculated one in general. The isocenter dose for the patient measured in solid phantom was agreed within $1.5\%$. On-axis dose profiles of each individual beam at the position of the central leaf measured with film and array detector were found that at out-of-the-field region, the calculated dose underestimates about $2\%$, at inside-the-field the measured one was agreed within $3\%$, except some position. Conclusion : It is necessary more tight quality control of MLC for IMRT relative to conventional large field treatment and to develop QA procedures to check intensity pattern more efficiently. At the conclusion, we did setup an appropriate QA procedures for IMRT by a series of verifications including the measurement of absolute dose at the isocenter with a micro-ionization chamber, film dosimetry for verifying intensity pattern, and another measurement with an array detector for comparing off-axis dose profile.

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Treatment Results of Radical Radiotherapy in Uterine Cervix Cancer (자궁경부암 환자의 근치적 방사선치료성적)

  • Huh Seung Jae;Kim Bo Kyong;Lim Do Hoon;Shin Seong Soo;Lee Jeong Eun;Kang Min Kyu;Ahn Yong Chan
    • Radiation Oncology Journal
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    • v.20 no.3
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    • pp.237-245
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    • 2002
  • Purpose : This study was conducted to evaluate the treatment results, prognostic factors, and complication rates after high dose rate (HDR) brachytherapy in patients with uterine cervix cancer who were treated with curative aim. Materials and Methods : Of 269 cervix cancer patients treated at the department of radiation oncology, Samsung Medical Center from September 1994 to July 1998, the 106 who were treated with radical radio-therapy were analyzed. The median age was 61 years (range 22 to 89). All patients except 4 with carcinoma in situ (CIS) were given external beam radiotherapy (range $30.6\~50.4\;Gy$ to whole pelvis) and HDR brachytherapy. The common regimens of HDR brachytherapy were a total dose of $24\~28\;Gy$ with $6\~7$ fractions to point A at two fractions per week. The median overall treatment time was 55 days (range 44 to 104) in patients given both external beam radiotherapy and HDR brachytherapy. Results : Early responses of radiotherapy were evaluated by gynecologic examination and follow-up MRI 1 month after radiotherapy. Treatment responses were complete remission in 72 patients, partial response in 33 and no response in 1. The overall survival (OS) rate of all patients was $82\%,\;and\;73\%$, and the disease free survival (DFS) rate was $72\%,\;and\;69\%$, at 3, and 5 years, respectively. The pelvic control rate (PCR) was $79\%$ at both 3 and 5 years. According to the FIGO stage,3 and 5 year OS were $100\%\;and\;50\%$ in CIS/IA, $100\%\;and\;100%$ in IB, $83\%\;and\;69\%$ in IIA, $87\%\;and\;80\%$ in IIB, and $62\%\;and\;62\%$ in III, respectively. The 3 year OS in 4 patients with stage IVA was $100\%$. Three-year DFS were $80\%$ in CIS/IA, $88\%$ in IB, $100\%$ in IIA, $64\%$ in IIB, $58\%$ in III, and $75\%$ in IVA. Three-year PCR were $100\%$ in CIS/IA, $94\%$ in IB, $100\%$ in IIA, $84\%$ in IIB, $69\%$ in III, and $50\%$ in IVA. By univariate analysis, FIGO stage and treatment response were significant factors for OS. The significant factors for DFS were age, FIGO stage, treatment response and overall treatment time (OTT). For pelvic control rate, treatment response and OTT were significant factors. By multivariate analysis, FIGO stage had a borderline significance for OS (p=0.0825) and treatment response had a borderline significance for DFS (0=0.0872). A total of 14 patients $(13\%)$ experienced rectal bleeding, which occurred from 3 to 44 months (median, 13 months) after the completion of radiotherapy. Conclusion : HDR brachytherapy protocol of Samsung Medical Center combined with properly optimal external beam pelvic irradiation is a safe and effective treatment for patients with uterine cervix cancer. The authors found that OTT of less than 55 days had a positive impact on pelvic control and survival rate.

Effects of Immunoactivity on Ascaris suum Infection in Mice (마우스에 있어서 멱역활성이 돼지회충의 감염에 미치는 영향)

  • Lee, Jae-Gu;Park, Bae-Geun;Seo, Yeong-Seok
    • Parasites, Hosts and Diseases
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    • v.29 no.3
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    • pp.279-292
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    • 1991
  • The immune response to sheep red blood cell (sRBC) was monitored in the mice infected with Ascaris strum or Trichinella spiralis. The effects of the infection with T. spiralis or the injection with cyclophosphamide (CY) as an immunosuppression agent prior to challenge infection with the embryonated eggs of A. suum were monitored in mice by means of the level of infection with A. strum and cellular and humoral immune response to sRBC. following the oral administration of 1, 000 eggs of A. suum to mice, delayed-type hypersensitivity (DTH) and rosette-forming rate were gradually decreased and reached to the lowest levels at the 5th week and 6th week postinfection, respectively, and then returned to normal at the loth week. The hemagglutinin (HA) and hemolysin (HE) titers were gradually elevated and reached to peak at the 3rd week postinfection, and then returned to normal level. The appearance ratios of the eosinophils and mast cells were in peak at the 4th week and the 2nd week postinfection, respectively. Meanwhile the harvest ratio of A. suum larvae from the liver and lungs was 21.97% at the 1st week postinfection. Following the oral administration of 300 T. spiralis infective larvae, DTH and rosette-forming rate were gradually decreased with the lapse of time and reached the lowest values in the 30th and 21st day of postinfection, and then slightly increased and transiently decreased in the 70th and 80th day of postinfection, respectively. HA and HE titers were the lowest in the 21st and 90th day, whereas the ratios of eosinophils and mast cells were the highest on the 40th and 14th day posti nfecti on, ruts petit i vela. Following the intraperitoneal injection of CY, the body weight, the spleen weight, DTH, rosette-orming ratio, HA and HE titers, the number of WBC and the ratio of the mast cell were predominantly decreased in the 5th day, and then returned to the same value of the 1st day postinjection. The ratio of eosinophils was gradually decreased following to advance of days. At the 1st, 5th and loth days after intraperitoneal injection of CY of 400 mg/kg, a dose with 1, 000 eggs of A. suum was administered orally to mice, and harvest rate of the larvae at the 7th day postadministration was 7.07% in the 1st day, 14.94% in the 5th day, 10.1% in the loth day, 8.02% in control group. The effect of prior infection with infective larvae of T. spiralis upon immunological sequelae of a challenge infection of mice with embryonated eggs of A. suum in 30 or 70 days interval was checked. On the 37th day of prior infection with T. spiralis, that was the 7th day with A. suum postinfection, DTH and rosette-forming rate were drastically decreased, but the ratio of mast cells was highly increased and the ratio of eosinophils, HA and HE titers were fairly increased. On the other hand, the rate of larvae harvest was 9.3% in experimental group in contrast with 22.18% in control group. Meanwhile the effect of immune response to sRBC was similar to that of the former, but DTH and rosettt-forming rate were greatly decreased in the 77th day after prior infection with the 7th day after challenge infection in compariton with control. At that time, Ascaris larvae were harvested 8.3% in experimental group in comparison with 10.5% in control group.

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Therapeutic Efficacy of Prednisolone Withdrawal Followed by Recombinant ${\alpha}$ Interferon in Children with Chronic Hepatitis B (소아 만성 B형 간염 환자에서 스테로이드 이탈 요법 후 인터페론 병용 투여의 치료 효과)

  • Ryu, Na-Eun;Kim, Byung-Ju;Ma, Jae-Sook;Hwang, Tai-Ju
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.2 no.2
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    • pp.169-177
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    • 1999
  • Purpose: To evaluate the efficacy of interferon alpha therapy with or without prednisolone in children with chronic hepatitis B. Methods: Twenty-eight children (22 boys, 6 girls, mean age 130 months) had seropositive results for HBsAg, HBeAg and HBV DNA; 11 had chronic persistent hepatitis and 17 had chronic active hepatitis. The patients were divided into two groups depending upon their inflammatory activity on liver biopsy, pretreatment serum ALT levels and HBV DNA levels. Fourteen children (group 1: chronic active hepatitis, ALT ${\geq}$ 100 IU/L and HBV DNA ${\leq}$ 100 pg/$300\;{\mu}L$) received interferon alpha 2a 5 $MU/m^2$ of body surface three times weekly for 6 months. Fourteen children (group 2: chronic persistent hepatitis or chronic active hepatitis with ALT < 100 IU/L or HBV DNA > 100 pg/$300\;{\mu}L$) received prednisolone in decreasing daily doses of 60 mg/$m^2$, 40 mg/$m^2$, and 20 mg/$m^2$, each for 2 weeks, followed after 2 weeks by interferon alpha 2a on the same schedule. At the end of therapy, 3 end points were analyzed: HBeAg seroconversion, serum ALT normalization rate and clearance of serum HBV DNA. Results: At the end of treatment, HBe antigen-to antibody seroconversion was higher but not more significant in group 1 than group 2 (71.4% vs. 50.0%). Only one patient in group 2 who lost HBeAg, also cleared HBsAg. ALT normalization was similar in both groups (64.3% in group 1 vs. 55.6% in group 2). Clearance of serum HBV DNA was observed in 78.6% of patients in group 1 and 64.3% in group 2, but no significant differences. Complete response was similarly achieved in both groups (57.1% in group 1 vs. 50.0% in group 2). Interferon alpha therapy with prednisolone priming was well tolerated and all children finished therapy. Conclusion: The combined therapy with prednisolone followed by interferon alpha may be safe and effective in inducing a serological and biochemical remission of the disease in approximately 50% of children with chronic hepatitis B and with a high level of viral replication and less active disease. However, a controlled study should be performed to confirm these results.

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Epidemiology and Clinical Manifestations of $Henoch-Sch\"{o}nlein$ Purpura in Children (소아 $Henoch-Sch\"{o}nlein$ 자반증의 역학 및 임상양상)

  • Kim Se-Hun;Lee Chong-Guk
    • Childhood Kidney Diseases
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    • v.7 no.2
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    • pp.166-173
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    • 2003
  • Purpose : The cause and pathogenesis of $Henoch-Sch\"{o}nlein$ purpura has been studied for many years but the results are disappointing. Recently the hypothesis that abnormalities involving the glycosylation of the hinge region of immunoglobulin Al(IgAl) may have an important role in the pathogenesis of $Henoch-Sch\"{o}nlein$ purpura is being approved. $Henoch-Sch\"{o}nlein$ purpura is the most common vasculitis Ihat affects children and the prognosis is good. But if kidney invovement occurs, the course may be chronic and troublesome. So we evaluated children with $Henoch-Sch\"{o}nlein$ purpura especially from the point of epidemiology and clinical manifestations. Methods : Investigation of 124 children who were diagnosed with $Henoch-Sch\"{o}nlein$ purpura at Inje University Ilsan Paik Hospital from December 1999 to July 2003 was performed retrospectively through chart review. Efforts were made to get informations about the profile, epidemiology, clinical manifestations, progress of the disease and recurrence rate of patients. Results : The patients were 69 boys and 55 girls, with a mean age of $6.1{\pm}2.7$ years at the time of data collection. The male to female ratio was 1.25 : 1. The occurrence rate was much higher in autumn(from September to November, 31.5%) and winter(from December to February, 28.2%) than in spring and summer, with a peak in November. Joint involvement was shown in 66.9% of patients mostly on the foot/ankle(75.9%), knee(39.8%). Seventy(56.5%) out of 124 patients had abdominal pain and 10 patients(8.1%) showed bloody stools. Renal involvement was observed in 24 patients(19.4%) after 21.1 days on the average. IgA was elevated in 10 of 21 patients(47.6%). $C_3$ and $C_4$ levels were normal in 40 of 49 patients (81.7%) and 47 of 48 patients(97.9%), respectively Antistreptolysin-O(ASO) titer was elevated over 250 Todd units in 29 of 62 Patients(46.8%). Mycoplasma antibody titer was elevated in 21 of 49 patients(42.9%) equal or greater than 1:80. Radiologic studies were peformed in 23 patients. Seven patients(30.4%) showed bowel wall thickening and one of them received intestinal resection and anastomosis operation due to terminal ileum necrosis. Eighty four patients took steroid 1.4 mg/kg/day in average. Recurrence rate was 2.5 in 37 patients(29.8%). Conclusion : $Henoch-Sch\"{o}nlein$ purpura in childhood appears most in about 6 years of age. The occurrence rate is much higher in autumn and winter relatively. Diagnosis can be made through the perspective history taking and the inspection of clinical manifestations, but the laboratory findings are not of great help. A small portion of the patients might show abdominal pain or arthritis before purpura develops, therfore various diagnosis can be made. Radiologic evaluation should be performed to avoid surgical complications in cases accompanying abdominal pain, and long term follow up should be needed especially in patients suffering from kidney involvement. In about 30% of the patients $Henoch-Sch\"{o}nlein$ purpura would recur. Steroid can be used safely without side effects.

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