• Clinical and Experimental Pediatrics
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• v.45 no.7
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• pp.828-835
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• 2002

Purpose : The outcomes of infants weighing less than 1,500 gm(very low birth weight infant : VLBWI) reflect recent progress in neonatal intensive care. In this study, we analyzed changes over time in survival rate and morbidity of VLBWIs during the past seven years. Methods : A retrospective review of medical records was analyzed for VLBWIs admitted to the neonatal intensive care unit of Samsung Medical Center within three days from birth. We compared the outcomes of previous corresponding data(period I : Oct. 1994 to Sept. 1996), with the outcomes of period II(Oct. 1996 to Dec. 1998) and period III(Jan. 1999 to Dec. 2000). Results : As shown in Tables 1 and 3, the distribution of birth weight, gestational age(GA), gender, and inborn admissions did not change during the 7-year study. The overall survival rate of VLBWI increased significantly over time(period I : 72% vs period III : 88.3%, P<0.05). Between period I and period II, the birth weight-specific survival rate increased by 23.6%(75% vs 92.7%, P<0.05) for infants 1,000 to 1,249 gm. Between period II and period III, the birth weight-specific survival rate increased three times(20% vs 66.7%, P<0.05) for infants <750 gm. The survivors of lowest birth weight included infants at 624 gm(GA : $26^{+5}$ weeks), 667 gm(GA : $25^{+6}$ weeks) and 480 gm(GA : $26^{+2}$ weeks) in each period. The gestational age-specific survival rate in period III increased significantly in GA 25-26 weeks and 29-30 weeks(vs period I & period II, P<0.05). The survivors of lowest gestational age included infants at GA 26 weeks(970 gm), GA $23^{+5}$ weeks(791 gm) and GA $24^{+1}$ weeks(740 gm) in each period. The incidence of severe IVH(grade III, IV) and the early death rate(< seven days) decreased in period III(vs period I; P<0.05), reflecting improvements in neonatal intensive care. Conclusion : The survival rate of VLBWI continues to increase, particularly for BW < 750 gm, GA < 26 weeks. This increase in survival is not associated by any increase in major morbidities.

• Radiation Oncology Journal
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• v.17 no.3
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• pp.203-208
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• 1999

Purpose : To evaluate whether spontaneous apoptosis has prognostic value among patients with squamous cell carcinoma of lung. Materials and Methods : Material from 19 patients who received thoracic irradiation between 1990 and 1994 was analyzed. Their stages were II (1), IIIa (8), IIIb (5), and IV (5). Patients were observed from 5 to 67 months (median : 17 months). The spontaneous apoptosis index (AI) and p53 mutation were measured by immunohistochemical stains. Results : AI was found to range from 0 to $1\%$ (median $0.4\%$). Patients with low AI ($AI{\leq}$median) had a much higher distant metastasis rate at diagnosis than patients with high AI. By analysis of prognostic factors for survival, M stage was significant in univariate analysis. AI, chemotherapy, M stage, T stage, and stage were significant in multivariate analysis. The correlation between the AI and p53 mutation was not seen. Conclusion : AI was related with distant metastasis at diagnosis and not with p53 mutation. Also low AI group tended to have shorter survival time than high AI group.

• Pediatric Infection and Vaccine
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• v.28 no.3
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• pp.133-143
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• 2021

Purpose: This study aimed to determine the incidence of central line-associated bloodstream infection (CLABSI) in the neonatal intensive care unit (NICU), evaluate the patients' clinical characteristics, and identify the etiologic agents for guidance in prevention and treatment. Methods: A retrospective chart review study of infants classified as having CLABSI was conducted at the NICU of Seoul National University Bundang Hospital from January 2016 to December 2020. Results: Of the 45 infants, 53 had CLABSIs within a follow-up period of 18,622 catheter days. The incidence of CLABSIs was 2.85 per 1,000 catheter days. The most common catheter type was a peripherally inserted central catheter (n=47, 81%). A total of 57 pathogens were isolated, of which 57.9% (n=33) were Gram-positive bacteria, 36.8% (n=21) were Gram-negative bacteria, and 5.3% (n=3) were Candida spp. The most common pathogens were Staphylococcus aureus (n=12, 21%) and coagulase-negative staphylococci (n=12, 21%), followed by Klebsiella aerogenes (n=8, 14%). The median duration of bacteremia was 2 days, and 19 episodes showed bacteremia for 3 days or more. The mortality rate of infants within 14 days of CLABSI was 13.3% (n=6). Conclusions: This study analyzed the incidence of CLABSI and the distribution of pathogens in the NICU. Continuous monitoring of CLABSI based on active surveillance serves as guidance for empiric antibiotic use and also serves as a tool to assess the necessity for implementation of prevention strategies and their impact.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.309-315
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• 2003

Background: To avoid the adverse effects of cardiopulmonary bypass and to overcome late vein graft failure we routinely peformed off-pump total arterial coronary revascularization. Material and Method: From July 2000 to August 2001, 104 consecutive patients underwent first elective off-pump total arterial coronary revascularization. Both internal mammary, radial and gastroepiploic arteries were used. Sequential and composite grafts were used to achieve complete revascularization. Perioperative adverse events and postoperative angiograms were analyzed. Result: A total of 252 arterial conduits were used with an average of 2.47 grafts per patient. A total of 326 distal anastomosis were performed with a mean of 3.13 distal anastomosis per patient. Cross over to on-pump occurred in seven patients (6.7%). Of these 4 were due to unstable hemodynamics during lateral or posterior wall stabilization as a result of cardiomegaly and 3 were due to uncontrolled bleeding during dissection of diffusely dimunitive deeply placed intramyocardial coronary arteries. There were no opeartive deaths. Two cases of perioperative myocardial infarction and transient neurologic complications occurred, respectively. Of the 312 distal anastomoses, 308 (98.7%) were compatible with Fitz-Gibboll A or B patency grading. Conclusion: Off-pump total arterial coronary revascularization was technically feasible in most elective cases with satisfactory early results. However, on-pump coronary bypass surgery should be considered in difficult circumstances, such as cardiomegaly or unfavorable anatomy of the target coronary artery.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.1
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• pp.58-65
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• 2010

Purpose: Since there are few studies involving acute pancreatitis in children, we reviewed our experience with this medical condition to describe the clinical features. Methods: A retrospective analysis was conducted by reviewing the medical records of 41 patients with AP who were admitted to the Department of Pediatrics of Pusan National University Hospital between January 1996 and June 2007. Results: Twenty males and 21 females (mean age, 8.7${\pm}$4.5 years) were included. In 22 patients (53.7%), no definitive causes were found. The most common etiologies were choledochal cysts (22.0%). Necrotizing pancreatitis was diagnosed in 5 patients (12.2%), and recurrent acute pancreatitis in 4 patients (9.8%). CT findings included pancreatic swelling (43.9%), peripancreatic fluid collection (29.3%), ascites (24.4%), and peripancreatic fat necrosis (12.2%). Serum amylase and lipase levels at diagnosis were 535.3${\pm}$553.2 and 766.2${\pm}$723.6 U/L, respectively, and were normalized within 1 week in 22 and 14 patients, respectively. On the basis of the Balthazar scale, 2 patients were diagnosed with severe AP. In 4 patients (9.8%), a surgical procedure was indicated. Major complications included ascites (32.3%), sepsis (16.1%), and pseudocyst and renal impairments (12.9%). Two patients died from multi-organ failure. Conclusion: The etiologies of AP in children are varied. Most children have a single episode and a self-limited course. However, AP of childhood still carries significant morbidity and mortality. Early diagnosis, appropriate treatment according to disease severity, and management of complications are important.

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.946-952
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• 2005

Purpose : Vancomycin-resistant enterococci(VRE) are now nosocomial pathogens in Korea. But little is known about the prevalence of stool colonization with VRE in neonates in Korea. So we studied the prevalence and risk factors of VRE colonization in the Neonatal Intensive Care Unit(NICU). Methods : From January 2000 to December 2004, the medical records of 294 neonates(127 cases of VRE group and 167 cases of non-VRE group, according to the results of stool culture) were reviewed retrospectively. We studied the annual prevalence of VRE and risk factors of VRE colonization in neonates. Results : From 2000 to 2003, the prevalence rate of VRE in NICU increased. After preventing VRE transmission, the prevalence rate of VRE has decreased. Conclusion : VRE colonization increased recently. Risk factors of VRE colonization were prematurity, lower birth weight, longer hospitalization and use of vancomycin or 3rd generation cephalosporin, compared with the non-VRE group. To prevent VRE transmission among newborns, aggressive infection control strategies by NICU staffs must be implemented immediately for all babies.

• Journal of Chest Surgery
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• v.34 no.4
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• pp.329-337
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• 2001

배경: 승포판 전엽이나 교련 또는 여러 판엽에 걸쳐 광범위한 병변으로 인한 승모판 역류의 경우 수술수기에 대한 뚜렷한 정립이 되어 있지 않은 실정이다. 최근 이러한 병변의 승모판 역류의 경우 PTEE(Polytetrafluro-ethylene)을 이용한 신건삭 형성술의 시행이 점차 늘고 있다. 이에 저자들은 PTEE를 이용한 신건삭 형성술이 승모판 성형술에 어떠한 영향을 미치는지 알아보고자 하였다. 대상 및 방법: 1994년 1월부터 1999년 12월까지 승모판막 성형술을 시행 받은 322명의 환자 중에서 신건삭 형성술을 이용하여 승모판 성형술을 시행한 144례(I군)과 신건삭 형성술 이외의 방법으로 승모판 성형술을 시행한 178례(II군)를 대상으로 하였다. 두 군에서 수술 직후ㅘ 수술 후 6개월, 1년 및 1년 단위로 주기적인 심초음파를 시행하였고 이를 통계적 검정하였다. 결과: 같은 기간 승모판 성형술은 승모판막 폐쇄 부전증으로 내원한 환자의 95%(306)에서 추적 관찰이 가능하였다. 두 구난에 수술 전 혈류 역학적인 차이를 보이지 않았고, 수술 전 평균 승모판막 폐쇄 부전의 정도는 I군이 3.8$\pm$0.4, II군이 3.6$\pm$0.3였으나 수술 후 추적 관찰에서 각각 1.3$\pm$0.9와 1.1$\pm$0.7 정도의 양호한 판막 성형술의 결과를 보였고 승모판막 면적의변화나 승모판막에서의 평균 압력차이 등 혈류 역학적인 결과에도 차이를 보이고 있지 않았다. 술 후 3명(0.9%)의 조기 사망과 4명 (1.2%)의 후기 사망이 있었으나 두 군간의 차이는 보이지 않았다. 만기 생존율( 93.7$\pm$3.3 vs 88.0$\pm$1.95) 및 판막살패가 발생하기 않을 확률( 93.7$\pm$3.6 vs 93.3$\pm$3.4%) 과 재수술이 필요치 않을 활률(99.3$\pm$0.7 vs 96.0$\pm$1.9%), 색전증, 감염성 심내막염, 판막과 관련된 합병증 발생률 등에서 두 군간에 의미 있는 차이는 없었다. 전엽과 후엽에서 신건삭 형성술을 시행한 환자에서는 통계학적인 차이가 없었다(p=0.29) 결론: 신건삭 형성술을 이용한 승모판 성형술은 승모판 성형술의 증가(r=0.98, p<0.01)를 가져 왔을 뿐만 아니라 내구성과 안정성에 있어 기존의 안전화된 수술 수기와 견줄만하다. 특히 이러한 신건삭 형성술은 승모판 전엽에 병변이 있는 경우와 교련부 및 여러 엽에 광범위한 병변으로 인하여 재건술이 어려운 경우에도 승모판 재건을 가능하게 하는 우수한 수술 수리가 사료된다.

• Proceedings of the Korea Water Resources Association Conference
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• 2004.05b
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• pp.839-843
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• 2004

최근 들어 수자원 계획과 관리에 대한 평가를 위해 수문, 사회, 경제 및 환경 지표들을 이용하여 평가하고자 하는 노력들이 지속되고 있다. 이를 통해 수자원의 여건을 여러 지표들을 통합한 통합지표로 평가함으로서 객관적이고 투명한 결과로 도출하고자 하고 있다. 여러 국제기구 및 연구단체에서는 최근 논의가 되고 있는 지속가능한 발전을 평가하기 위해 각 국가별 자료를 수집하여 지표분석을 통해 각 국가별 상황을 제시하고 있다. 대표적인 통합지표로는 WPI(Water Poverty Index), HDI(Human Development Index)와 ESI(Environmental Sustainability Index) 등이 있으며 이 외에도 OECD, SEI 등과 같은 국제기구들이 여러개별 지표들을 통하여 지속가능성을 평가하고자 하고 있다. 또한 가상의 물 교역(virtual water trade)을 통해 개발된 지표들을 이용하여 각 나라의 수자원 현황을 평가하였다. 본 연구에서는 개발되었던 경제, 사회의 통합지표인 HDI, 환경 통합지표인 ESI, 수자원관련 통합지표인 WPI 등을 소개하고 이를 통해 우리나라의 지속가능성을 평가하여 보았다. 또한 Virtual Water Trade를 통해 국가별 수자원 현황을 평가하였고 여러 개별지표 등을 통해 수자원 뿐만 아니라 경제, 사회, 환경 등 여러분야에 대해 우리나라의 상황을 알아보았다. 이 연구를 통해 정확하게는 분석이 이루어진다고 말할 수는 없지만 정책결정에 도움을 줄 수 있는 정보를 제공하였다고 생각된다. 또한 국내, 외의 여러 지표를 통해 국내 실정에 맞는 우리나라의 수자원을 평가할 수 있는 통합적인 수자원관련 지표 개발에 많은 도움을 주었으리라 사료된다.DEM 자료로 변환하였다. 또한 유역의 고도차를 이용한 흐름특성 분석을 위해 수치고도자료를 이용하여 유역흐름특성을 분석할 수 있는 TOPAZ(Topographic PArameteri-Zation) 프로그램을 이용하였다. TOPAZ 프로그램을 통해 분석된 각 격자별 분포형 수문 매개변수는 적합한 관계식을 통해 분포형 유출량을 모의하는데 적용된다.다 정확한 유입량 예측이 가능할 것으로 사료된다.이 작은 오차를 발생하였으며, 전체적으로 퍼프 모형이 입자모형보다는 훨씬 적은 수의 계산을 통해서도 작은 오차를 나타낼 수 있다는 것을 알 수 있었다. 그러나 Gaussian 분포를 갖는 퍼프모형은 전단흐름에서의 긴 유선형 농도분포를 모의할 수 없었고, 이에 관한 오차는 전단계수가 증가함에 따라 비선형적으로 증가하였다. 향후, 보다 다양한 흐름영역에서 장${\cdot}$단점 분석 및 오차해석을 수행한 후에 각각의 Lagrangian 모형의 장점만을 갖는 모형결합 방법을 제시할 수 있을 것으로 판단된다.mm/$m^{2}$로 감소한 소견을 보였다. 승모판 성형술은 전 승모판엽 탈출증이 있는 두 환아에서 동시에 시행하였다. 수술 후 1년 내 시행한 심초음파에서 모든 환아에서 단지 경등도 이하의 승모판 폐쇄 부전 소견을 보였다. 수술 후 조기 사망은 없었으며, 합병증으로는 유미흉이 한 명에서 있었다. 술 후 10개월째 허혈성 확장성 심근증이 호전되지 않아 Dor 술식을 시행한 후 사망한 예를 제외한 나머지 6명은 특이 증상 없이 정상 생활 중이다 결론: 좌관상동맥 페동맥이상 기시증은 드물기는 하나, 영유아기에 심근경색 및 허혈성 심근증 또는 선천성 승모판 폐쇄 부전등을 초래하는 심각한 선천성 심

• Journal of Chest Surgery
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• v.37 no.8
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• pp.672-683
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• 2004

Background: The treatment results of the advanced lung carcinoma is not satisfactory with the present therapeutic modalities: surgical resection, anti-cancer chemotherapy, and radiotherapy or combination therapy. To predict the prognosis of the non-small-cell lung carcinoma, TNM classification has been was as the basic categorization; however, it has been not satisfactory. It is necessary to consider the causes and the prognosis of the lung carcinoma from another points of view rather the conventional methods. We intended to find out the relationship between the major apoptotic factor, p53 gene and the prognosis of the patient with lung carcinoma. Material and Method: Three hundreds and fifty-nine patients with lung carcinoma who underwent surgery were analysed. We observed p53 protein accumulated in the cellular nuclei. The p53 protein was detected by immuno-histo-chemical method. We collected information of the patient retrospectively. Result: p53 protein densities were observed in 40% in average as a whole. The protein density was 44 percent in man, 25 percent in woman, 49 percent in the squamous cell carcinoma, and 38 percent in the adenocarcinoma. There were significant correlations between the p53 protein density and the mortality in the squamous cell carcinoma (p=0.025), follow-up duration in TNM stage I group (p=0.010), and follow-up duration in the lobectomy patient group (p=0.043), and tumor cell differentiation (p=0.009). p53 protein densities were significantly different between the lobectomy and the pneumonectomy group (p=0.044). Conclusion: The authors found that p53 protein had some correlations with the prognosis of the lung cancer partially in some factors. We suggest the p53 protein density could be used as a marker of prognosis in the non-small-cell lung carcinoma.

• Tuberculosis and Respiratory Diseases
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• v.47 no.2
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• pp.195-208
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• 1999

Background: Pulmonary infiltrate in immunocompromised hosts has many infectious and non-infectios etiologies. To evaluate the diagnostic yield and therapeutic implication of two invasive diagnostic methods, such as bronchoscopy and surgical lung biopsy, we performed retrospective analysis of these patients. Methods: All immunocompromised patients admitted to Samsung Medical Center from October 1995 to August 1998 who underwent bronchoscopy and/or surgical lung biopsy for the diagnosis of pulmonary infiltrates were included in this study. Confirmative diagnostic yield, the rate of changed therapeutic plan and patients' survival were investigated. Results: Seventy-five episodes of pulmonary infiltrates developed in 70 patients(M : F=46 : 24, median age 51). Underlying diseases of patients were hematologic malignancy(n=30), organ transplantation(n=11), solid tumor(n= 12), connective tissue disease(n=6) and others. Confirmative diagnosis was made in total 53 cases (70.7%), of which 70.2% had infectious etiology. Diagnostic yields of bronchoscopy, bronchoalveolar lavage(BAL), transbronchiallung biopsy(TBLB) and surgical lung biopsy were 35.0%(21/60), 31.4%(16/51), 25.0%(9/36) and 80.0%(20/25). Therapeutic plan was changed in 40%(24/60) of patients after bronchoscopy and in 36%(9/25) of patients after surgical lung biopsy. More patients survived (84.4% vs 60.5%, p=0.024) when therapeutic plan was changed after invasive diagnostic study. Conclusion: Bronchoscopy and surgical lung biopsy are helpful for the therapeutic implication of pulmonary infiltrates in immunocompromised hosts. Large-scale prospective case-control study may further clarify their limitation and usefulness.