• Journal of Trauma and Injury
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• 제27권4호
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• pp.115-125
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• 2014

Purpose: Stable vital signs (SVSs) are thought to be the most important criteria for successful non-operative management (NOM) of blunt spleen injury (BSI). However, a consistent definition of SVSs has been lacking. We wanted to evaluate the diversity of the definitions of SVSs by using a nationwide survey. Methods: A questionnaire regarding the definition of SVSs was sent to the trauma surgeons working at the Department of Trauma Surgery and Emergency Medicine at a level-I trauma center between October 2011 and November 2011. Data were compared using analyses of the variance, t-tests, ${\chi}^2$ tests and logistic regressions. Results: Among 201 surgeons, 198 responded (98.2%). Of these 198 responses, 45 were incomplete, so only 153 (76.1%) were analyzed. In defining the SVSs, significant diversity existed on the subjects of type of blood pressure (BP), cut-off value for hypotension, technique for measuring BP, duration of hypotension, whether or not to use the heart rate (HR) as a determinant, cut-off value of hypotension when the patient had a comorbidity or when the patient was a child. Of the 153 surgeons whose responses were analyzed, 91.5% replied that they were confused when defining SVSs. Conclusion: Confusion exists regarding how to define SVSs. Most surveyed surgeons felt that a need existed to clarify both the definition of SVSs and the use of SVSs to determine hemodynamic stability for NOM.

• Childhood Kidney Diseases
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• 제23권2호
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• pp.116-120
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• 2019

Bilateral renal obstruction is a rare critical condition, requiring a prompt diagnostic approach and treatment to restore the renal function. The most commonly observed obstructive uropathy in children is congenital malformation, such as posterior urethral valves and bilateral ureteropelvic junction obstruction. Malignant pelvic masses obstructing the ureter are widely reported in adults but are rarely observed in children. The treatment of ureteral obstruction related to pelvic malignancy is a therapeutic challenge with a median survival duration of 3-7 months in adults; however, pediatric patients with pelvic malignancy leading to ureteral obstruction had better outcomes, with a reported 5-year mortality rate of 20%, than the adult patients. Here, we report a rare case of bilateral ureteral obstruction associated with pelvic rhabdomyosarcoma presenting with acute kidney injury treated by ureteral diversion with double J stent, and concommittent emergency hemodialysis, leading to restoration of good renal function. We suggest that bilateral ureteral obstruction should be released as soon as possible using surgical or interventional approach to minimize the obstruction period, and subsequential chemotherapy may contribute to improvement of survival and recovery of renal function.

• 대한영상의학회지
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• 제81권4호
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• pp.806-831
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• 2020

근골격계의 외상은 소아가 응급실로 내원하는 가장 흔한 원인 중에 하나이다. 소아에서 뼈는 아직 완전히 골화가 되지 않았기 때문에 불완전 골절(소성변형, 생나무 골절, 죔쇠 골절)과 같이 성인과는 다른 영상의학적 특성을 보이기도 하며, 성장판의 손상으로 인해 성장 장애를 유발하기도 한다. 소아는 연령에 따라서 활동 범위나 활동 양상이 다르기 때문에 분만 손상에서부터 낙상, 교통사고에 이르기까지 다양한 기전에 의해서 골절이 발생하며, 각각의 손상기전에 따라 특징적인 골절의 발생 부위 및 골절의 형태를 보이기도 한다. 본 종설에서는 소아의 다양한 근골격계 외상 중 소아에서 흔하게 볼 수 있는 사지 골절의 영상의학적 특성에 대해서 고찰해보고자 한다.

• Archives of Plastic Surgery
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• 제44권2호
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• pp.144-149
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• 2017

Background The purpose of this study was to identify the epidemiologic characteristics of hand tendon injuries in children and to compare these with those of adults. Methods This retrospective study was conducted on acute traumatic tendon injuries of the hand treated at our institution from 2005 to 2013, based on medical records and X-ray findings. Age, sex, hand injured, mechanism of injury, tendons and zones injured, number of affected digits, and comorbidities and complications were analyzed. Patients were divided into 2 groups: a pediatric group (${\leq}15years$) and an adult group (>15 years). Results Over the 9-year study period, 533 patients were surgically treated for acute traumatic tendon injuries of the hand. In the pediatric group (n=76), being male, the right hand, the extensor tendon, complete rupture, the middle finger, and glass injury predominated in hand tendon injuries. In the adult group (n=457), results were similar, but injury to the index finger and knife injury were the most common. An accompanying fracture was more common in the adult group and complication rates were non-significantly different. Conclusions This comparative analysis revealed no significant epidemiologic intergroup differences. The belief that pediatric tendon injuries tend to be less severe is misplaced, and careful physical examination and exploration should be conducted in pediatric cases of hand injury.

• Journal of Trauma and Injury
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• 제20권2호
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• pp.83-89
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• 2007

Purpose: This research was performed to determine which clinical signs and symptoms of brain injury are sensitive indicators of skull fracture (SF) and intracranial injury (ICI) in head injured children. Methods: We conducted a prospective study of minor head trauma in children younger than 2 years of age for a 1-year period. Skull radiographs, brain computed tomography (CT), and data forms, including mechanism of injury, symptoms, physical findings, and hospital course, were completed for each child. Results: Of 137 study subjects, 17 (12.4%) had SF/ICI. Falls were the most common mechanism of injury, and heights of fall above 1 meter were associated with incidence of SF/ICI (p<0.05). Scalp abnormalities were not associated with incidence of SF/ICI. As for clinical symptoms, lethargy and a grouping of features (irritability & vomiting) were associated with incidence of SF/ICI (p<0.05). The incidence of seizure, loss of consciousness, vomiting, irritability, and scalp abnormality did not differ significantly between those with normal radiologic findings and those with SF/ICI. Among asymptomatic patients, 11 (14.5%) patients had SF/ICI, and among patients with normal scalp findings, 9 (12.7%) patients had SF/ICI. Conclusion: Clinical signs and symptoms, except for lethargy and a grouping of features (irritability & vomiting), were not sensitive predictors of SF/ICI. Nevertheless, SF/ICI occurred among normal children. In such a case, a liberal policy of CT scanning is warranted.

• Clinical and Experimental Pediatrics
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• 제50권5호
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• pp.436-442
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• 2007

목 적 : 아동학대는 학대받은 아동의 신체적, 정신적 장애를 초래할 뿐 아니라 아동학대의 피해자가 성인이 되어 또 다른 가해자가 되는 악순환을 초래하는 등 후유증이 크기 때문에 피해 아동들의 특징과 손상을 임상적으로 분석함으로써 소아과 의사로서 아동 학대의 심각성을 인식하고 조기 진단과 치료, 향후 예방을 위해 지속적으로 노력해야 할 필요성을 강조하고자 본 연구를 시행하였다. 방 법 : 1999년 1월부터 2005년 12월까지 한림대학교 성심병원에 내원하여 아동학대로 추정되거나 진단된 18세 미만 소아 환아 20명을 대상으로 하였다. 환아들의 의무 기록을 후향적으로 검토하여 연령 및 성별, 학대 유형, 가해자, 가족의 특징 및 위험 인자, 내원 당시 주 증상, 진찰 소견, 손상의 종류와 정도, 치료 결과 및 예후에 대해 조사하였다. 결 과 : 연령분포는 1세 이하가 14명(74%)으로 가장 많았고, 평균 연령은 2.8세였으며, 성별 분포는 1:1로 비슷한 양상을 보였다. 대다수에서 첫 방문 당시 응급실로 내원하였으며 오후 6시부터 오전 8시 사이였다. 신체적 학대가 17례(85%)로 가장 많았으며, 다수에서 정신적 학대와 방임의 병력이 동시에 관찰되었다. 대상 환아의 70%에서 가해자를 확인할 수 있었으며, 부모에 의한 학대가 11례로 가장 많았다. 첫 내원 증상으로 경련이 8례로 장 많았고, 진찰 소견으로는 멍과 부종 등의 피부 손상이 가장 많았다. 골격계 정밀 검사를 시행했던 15례 중 6례에서 두개골 골절이 관찰되었고, 13례에서 두개내 출혈을 포함한 두개내 병변이 관찰되었다. 17례(85%)에서 입원 치료가 이루어졌으며 8례는 수술적 치료가 시행되었고, 총 4례가 사망하였다. 내원 당시 학대가 명백한 경우는 본원 사회사업과와 협의 진료 후 경찰서 또는 아동학대예방협회에 신고하였으며, 가해자에 대해서는 사회사업과와의 면담, 아동학대에 대한 교육, 정신과적 치료 등을 통해 재발 방지를 위한 노력이 있었다. 결 론 : 아동 학대는 사망률이 높고 생존자에서도 추후 신체적, 정신적으로 심각한 후유증을 남길 수 있으며 많은 수에서 재학대를 경험하므로 조기 발견 및 예방이 매우 중요하다. 따라서 학대가 의심되는 환아는 여러 방면의 전문가에 의해 철저한 검사가 시행되어져야 하고 소아과 의사로서 아동학대의 심각성을 인식하고 지속적인 관심과 예방을 위한 노력이 필요하다.

• 가정과삶의질연구
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• 제18권1호
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• pp.1-16
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• 2000

The purpose of this study was to explore marital violence from a communication perspective. A total of 352 marital couples in Pusan completed a structured questionnaire. The major findings were as follows: 1,. Husbands and wives reciprocally inflicted psychological aggression and physical violence. But husbands were more to inflict sexual violence and injury toward their wives. 2. When husbands have more the distractor and the blamer of communication style. they inflicted more physical violence toward their wives. When wives have more the blamer of communication style they inflicted more psychological aggression and physical violence toward their husbands. 3, Housbands inflicted psychological aggression toward their wives when husbands experienced child abuse from their parents. husbands inflicted physical violence toward their wives when husbands have the distractor of communication style experienced witness of spousal violence between father and mother and experience of scho l violence experience in the middle and high school. Wives inflicted psychological aggression toward their husbands when wives experienced witness of spousal violence between father and mother and have the blamer of communication style. Wives inflicted physical violence toward their husbands when wives experienced child abuse from their parents.

• Clinical and Experimental Pediatrics
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• 제52권12호
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• pp.1327-1336
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• 2009

Increasing numbers of children and adolescents prefer undertaking physical exercise to overcome overweight or obesity. Children and adolescents are in the growth stage and require adequate nutrient supply. More calories and nutrients are required especially when they are engaged in physical exercise. Exercise is the only means to increase lean body mass and decrease body fat, but adequate nutrient supply is also essential. Lack of adequate nutrient supply causes muscle mass loss, menstruation irregularity, reduced bone density, fatigue, or frequent injury in children undertaking physical exercise. Here, I have introduced some guidelines on the nutrient requirement for child and adolescent athletes.

• 아동학회지
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• 제30권3호
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• pp.55-69
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• 2009

The purpose of this study was to describe preschoolers' perceptions of fear from their own perspective. Qualitative data from 213 preschoolers 4 to 6 years of age were obtained by semi-structured interviews. The fear inventory was analyzed by content analysis and frequency. The most common fears of preschoolers in this study were fear of ferocious animals and imaginary figures, such as tigers, lions, snakes, spirits and ghosts. Fear of ghosts was the primary fear of both boys and girls. Results showed that most fears were caused by disgust-related visual images. Worry about injury and pain was another common pathway to fear. At-risk preschoolers scored significantly higher than normal preschoolers on fears of criticism and getting an injection.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제17권2호
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• pp.98-105
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• 2006

Objectives : To consider which questions are most useful clinically and to find a framework for assessment of suicidality or risk of suicide for adolescents. Methods : Authors reviewed and integrated both clinical works and researches about measures used to evaluate suicidal behaviors in adolescents. Results : The 'cascade approach' for assessment of suicidality was developed; the quality and quantity of 'distress' leads to an entry question to do with the 'quality of life' and whether it is worth living. These two questions lead to examinations of 'thoughts' which may lead to 'plans' which leads to 'threats' which then leads to 'deliberate self injury' and then on to a history of 'past suicide attempts'. Authors also suggested to use a summed score of cascade approach in clinical decisions and showed how to modify it up to different evaluation situations. Focusing on the good things helps not only to qualify suicidality but also to begin the search for solutions. Conclusion : In the clinical assessment process, while scales assist the clinician, there is nothing to supplant a sensitive clinical approach. The 'cascade approach' was proposed as a framework for assessing adolescents for suicidality.