• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.671-689
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• 2008

The economic recession of North Korea has been prolonged, the need for humanitarian assistance for the women and children of DPRK has been raised. In March 2006, South Korean government signed MOU with World Health Organization (WHO) to financially support "Improving Women's and Children's Health in DPRK (IWCH)" project. The assistance projects through UNICEF and the non-government organizations of South Korea were also followed. IWCH project consists of three parts; nutrition, disease management, children and maternity care. The first term (2006-2007) of the project leading by WHO was finished, and the second term (2008-2010) is just begun. The projects driven by NGOs have relatively been delayed due to difficulties in negotiating on project contents and places with North Korea. Recently, however, re-modeling processes of an obstetric/gynecology hospital and a children hospital in Nampo were started. Up to recently, South Korean government has played only a limited role in the humanitarian assistance for North Korea. IWCH project is, however, a full-scale initiative driven by government based on a systematic review of need and priorities. A significant amount of budget and relatively long term (five year) project compare to the previous short term and small size programs were expected to make more meaningful achievement. Despite these positive aspects, the project remains a list of unsolved problems a lack of mutual trust, a different decision making process between South and North Korea, a lack of conflict management process, and unpredictability and complexity of international politics. In spite of such kind of political uncertainty, the health care sector will be a leading area in the process of improving relationship between South and North Korea, particularly, humanitarian assistance for women and children will play a crucial role in the process. The successful implementation of IWCH project, therefore, will contribute to provide the reference model in developing the mutually constructive relationship between South and North

• Childhood Kidney Diseases
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• v.9 no.2
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• pp.137-142
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• 2005

Purpose : Acute poststreptococcal glomerulonephritis(APSGN) follows infection of group A$\beta$-hemolytic streptococci. The prognosis of APSGN has been reported as favorable. However, several studies have reported that some patients progress to chronic renal failure. In an attempt to clarify this, we analyzed the clinical course of patients with APSGN. Methods : Between January 2000 and December 2004, a total of 48 children who were diagnosed with APSGN according to the presence of hematuria, transient hypocomplementemia and evidence of group A $\beta$-hemolytic streptococcal infection were evaluated. Results : Six(12.5$\%$) patients showed elevation of serum creatinine level but there was no patient with Persistent renal dysfunction. Blood pressure was controlled with ease in all patients and there was no case of persistent hypertension. Renal biopsy was done in 5 patients who showed heavy proteinuria or renal insufficiency and the outcomes showed findings consistent with ordinary APSGN except one with findings of rapidly progressive glomerulonephritis(RPGN). Serum complement levels normalized within 8 weeks(92.9$\%$). Hematuria disappeared within 6 months(79$\%$) and proteinuria within 6 months(100$\%$) from the disease onset. Conclusion : Prolonged renal dysfunction or heavy proteinuria found in five patients(10.4$\%$) led to renal biopsy. All these problems resolved within 6 months. Our data support that the prognosis of childhood APSGN is favorable without any serious sequoia. (J Korean Soc Pediatr Nephrol 2005;9:137-142)

• Journal of Chest Surgery
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• v.30 no.3
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• pp.287-292
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• 1997

.Itrial fibrillation is one of the most common cardiac arrhythmias requiring treatment. About 60% of patients with mitral valvular disease have atrial fibrillation and one third of patients with atrial fibrillation may have the past history of thromboembolic events. Between April 1994 and June 1995, 20 patients with organic heart diseases combined with atrial fibrillation underwent open heart surgery including Cox-maze 111 procedure. There were 6 men and 14 women with an average age of 48 years (range, 31 to 66 years). Nineteen patients had valvular heart diseases and 1 ventricular septal defEct (VSD). Mean duration of atrial fibrillation was 36 months (:42 months) (range, 1 to 132 months). T e past medical history of thromboembolic events was positive in 7 patients (35%) and left atrial thrombus was detected in 9 patients (45%). The concomitant procedures were mitral valve replacement (MVR) and aortic valve replacement (AVR) in 5 patients, MVR in 4, MVd and tricuspid annuloplasty(TAP) in 4, mitral valvuloplasty(Mln) in 3, Mln and Tln in 1, MIW and coronary artery bypass surgery in 1, AVR in 1, and patch closure of VSD in 1. Mean aortic cross-clamping time was 175 minutes (range, 116 to 270 minutes). Atrial fibrillation recurred in 16 patients (80%) during the early postoperative period, but, recurrent atrial fibrillation was converted to regular rhythm at postoperative forty-first day in average. There was no early or late death in this series of 20 patients and postoperative complications were inappropriate tachycardia in 5 patients (25%), low cardiac output syndrome in 3 (15%), aggravated hemiplegic in 1, and acute renal failure in 1. Mean follow-up interval of patient was 16.5 months (range, 10.5 to 24 months) and all patients are currently in regular rhythm. Seventeen patients (85%) are in sinus rhythm and 3 (15%) in junctional rhythm. Right atrial contraction was detected in 95% of patients and left atrial contraction in 63% on postoperative transthoracic echocardiogram. The surgical treatment of atrial fibrillation concomitant with open heart surgery is warranted in the recent clinical setting of improved myocardial protection technique, considering the untoward side-effects of atrial fibrillation.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.282-286
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• 1997

In the era of coronary artery bypass grafting, the intraaortic balloon pump (IABP) is more widely used and its indication has been ex anded. We perf'orbed retrospective clinical analysis on the patients who have received IABP pre andfor postoperatively during the course of CABG. From January 1981 to June 1995, total 322 patients have received CABG at the Seoul National University Hospital and among them 50 patients (15.5%) were supported by IABP during the course of the operation. The mean age at the time. of the operation was 57.2 years (39∼ 75 years) and the male to female ratio was 33 : 17. The preoperative diagnosis was unstable angina in 33 (66%), stable angina in 7 (14%) and postinfarct angina in 8 patients(16%). As for the indications of the IABP, there were 13 cases(26%) with left main disease, 13 (26%) with class IV angina, 12 (24%) with difficulty in CPB weaning, 6 (12%) with postinfarct angina and 3 (6%) with severe LV dysfunction. In the remaining 3 cases, one patient was operated on after PTCA failure in emergency basis, another was a patient with AMI, and the other was one who had postoperative low c rdiac output syndrome. All IABPS were introduced via femoral artery and among them 45 cases (90%) percutaneously. The mean postoperative assist time was 22.3 hours (0.5 ∼ 168 hours) and IABP could be removed within 48 hours in most of them (44150). The operative mortality was 6.1% (3 cases) and postoperative morbidity was only one with lower extremity ischemia. The more general application of the IABP during the course of the CABG ,especially in patients with high preoperative risk factors or difficulty in CPB weaning is a good measure of protecting and recovering myocardial function with minimal risk.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.591-597
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• 2008

Background: Pulmonary endarterectomy is widely accepted as a treatment for chronic thromboembolic pulmonary hypertension. Based on our experiences, we sought to find ways to reduce perioperative complications and to improve surgical outcomes in patients undergoing pulmonary endarterectomy. Material and Method: This study was designed as a retrospective analysis of 20 patients with pulmonary hypertension who underwent pulmonary endarterectomy between January 1998 and March 2008. All patients presented with chronic dyspnea. Deep vein thrombosis (DVT) was the major cause of chronic pulmonary thromboembolism (55%). Seventeen patients (85%) underwent inferior vena cava (IVC) filter placement. Thirteen patients underwent surgery under total circulatory arrest, while the others underwent surgery while on low flow cardiopulmonary bypass. Concomitant tricuspid annuloplasty was done in 6 patients (66%) whose tricuspid regurgitation was as severe as grade IV/IV. The mean follow-up duration was $45{\pm}32$ months. Result: Using of University of California, San Diego (UCSD), thromboembolism classification, 4 patients (20%) were type 1, 8 patients (40%) were type II, and 8 patients (40%) were type III. Right ventricular systolic pressure was reduced significantly from $77{\pm}29$ mmHg to $37{\pm}19$ mmHg after pulmonary endarterectomy (p<0.001). The degree of tricuspid regurgitation and the NYHA functional class were all improved postoperatively. Reperfusion edema occurred in 7 cases (35%). The incidence of reperfusion edema was higher in the UCSD type III group than in the other group (25% vs 50%, p=0.25) and the length of postoperative intensive care unit stay was longer in type III group ($5{\pm}2$ days vs $9{\pm}7$ days, p=0.07). The early mortality rate was 10%, and the late mortality rate was 15% (n=3); one death was due to progression of underlying non-Hodgkin's lymphoma, and the other deaths were related to recurrent thromboembolism and persistent pulmonary hypertension, respectively. Conclusion: Pulmonary endarterectomy, as a curative surgical method for treating chronic thromboernbolic pulmonary hypertension, should be performed aggressively in patients diagnosed with chronic thromboembolic pulmonary hypertension, and an effort should be made to reduce the frequency of perioperative complications and to improve surgical outcomes.

• Journal of Korean Ophthalmic Optics Society
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• v.17 no.2
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• pp.159-164
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• 2012

Purpose: Of the various methods of vision training, the essay aims to explore the effective ways of using the Fresnel prism lens in order to expand the positive fusional vergence for the patient having specific condition of convergence insufficiency or basic exophoria. Methods: 15 students of city of Daejeon university without an eye disease (average age $22.73{\pm}1.68$) were selected and underwent the subjective refraction test and binocular vision test, and recording their test results before vision training and replacing an identical frame with a lens of same quality after the full calibration, the lens was then adhered with the Fresnel prism lens and continued to train for thirty minutes daily during two weeks. Afterwards, the binocular vision test was reattempted. The observation of the change in the results of the binocular vision test in use of the fresnel prism lens in the vision training test was researched. Results: After training, the positive fusional vergence had increased to a number of $22.27{\pm}2.26$ $\Delta$, to 7.80 $\Delta$, at near, the fused cross cylinder test increased to an average of $0.55{\pm}0.09$ D, 0.40 D after training, showing a normal result. The value of negative relative accommodation after training had an average of $2.22{\pm}0.08$D, showing that 0.42 D had increased. The value of near point of convergence after training had an average of $6.13{\pm}0.53$ cm, showing that 2.80 cm had decreased. To patients who had convergence insufficiency or basic exophoria, the value of the near vision test that used the Fresnel prism lens which was able to expand BO positive fusional vergence had increased without phoria. Conclusions: The changes were tested and the effectiveness of the Fresnel prism lens, due to the nature of the lens itself, helped with both cosmetic effects and cost. It also allows good optical correction effects, in addition to these clinical effects indicated before. Therefore, it may be determined that the Fresnel prism lens binocular vision therapy for patients is more popular and highly recommended.

• Clinical and Experimental Pediatrics
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• v.45 no.4
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• pp.459-465
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• 2002

Purpose : The aim of this study was to evaluate the latest tendency of esophageal foreign body's extraction and to obtain a consensus from recent trends of indications and techniques of flexible endoscopy of esophageal FB in children. Methods : We retrospectively reviewed medical records of 127 cases with foreign bodies in esophagus at Dept. of Pediatrics and Otorhinolaryngology, Gyeongsang National University Hospital (GNUH) from Jun, 1987 to July, 2001. They were divided into two groups by the kinds of endoscopy : flexible endoscope(66 cases) or rigid endoscope(61 cases). Rigid endoscopy was performed under general anesthesia at Dept. of Otorhinolaryngology but flexible endoscopy was performed without general anesthesia or sedative drugs(midazolam or diazepam). Results : An annual number of cases of two groups were similar from 1991 to 1998. But from 1999, flexible endoscopy was performed actively. Asymptomatic cases were frequently observed in flexible endoscopy(28 cases/66 cases) but swallowing difficulties were frequently observed in the rigid endoscopy group(25 cases/61 cases). Other symptoms were vomiting, irritability, chest discomfort and abdominal pain. The total number of cases with underlying disease(esophageal stenosis, cerebral palsy) was 8. The total number of cases with complications (erosion, ulcer, bleeding, perforation) was 11. The above cases were not correlated between the two groups. In 55 cases(83.3%) of the flexible endoscopic group and 53 cases(86.8%) of the rigid endoscopic group, foreign bodies in the esophagus were removed within 24 hours. Conclusion : We could not find any benefit in rigid endoscopic technique. Flexible endoscopic FB removal can be performed safely and effectively in children by an experienced endoscopist.

• Clinical and Experimental Pediatrics
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• v.46 no.6
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• pp.561-565
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• 2003

Purpose : Urinary tract infection(UTI) is the most common bacterial infectious disease that may induce severe renal injury unless early diagnosis and appropriate treatment are performed. If recurrent UTI is prevented, renal injury can be also reduced. Therefore, we studied the risk factors of recurrent UTI in children. Methods : We performed a retrospective study of 168 children(58 girls and 110 boys) who were treated for UTI in the Department of Pediatrics, Korea University Medical Center, during 2000-2001. Among 168 children, 93 children were followed up for more than six months. For the detection of recurrence of UTI, we performed monthly routine urine cultures and physical examinations. Results : The total rate of recurrence was 32.3%. The recurrent rate in boys and girls were 37.1% and 17.4%, respectively(P<0.05). The most common causative bacteria in the first onset and in recurrence were Escherichia coli. There was a significant difference in the onset age of UTI between boys with recurrence($4.8{\pm}1.0months$) and without recurrence($16.5{\pm}3.8months$)(P<0.01). In 77% of cases, urinary tract infection recurred within six months of the first infection. The time of the first recurrence after UTI was $3.7{\pm}0.6months$ in boys and $14{\pm}8.2months$ in girls(P<0.01). The number of recurrences showed a significant difference between the group under the age of one year($0.69{\pm}0.8/year$) and those above the age of one year($0.16{\pm}0.4/year$)(P<0.05). There was no difference in the recurrent rate between those with structural abnormality and those with normal anatomy. Conclusion : Monthly routine urine cultures are efficient in detecting recurrent UTI in children. Because the male sex and young age especially less than one year of age are risk factors for increased recurrence rate of UTI, these children should be followed-up with urine cultures.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1194-1199
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• 2003

Purpose : To determine the change in the limit of viability in fetal infants and the incidence of major complications in neonatal intensive care unit(NICU) at Samsung Medical Center(SMC). Methods : Sevety-three infants weighing less than 800 g at birth and 117 infants born earlier than 27 weeks gestational age, who were admitted to NICU at SMC between November 1994 and December 2002, were enrolled. Their medical records were reviewed with a focus on the survival and major complications, including chronic lung disease, retinopathy of prematurity, intraventricular hemorrhage, and periventricular leukomalacia. The limit of viability in fetal infants was defined as the birth weight or gestational age at which a 50% survival rate is reached and the incidence of major complications were compared by period(period I : Nov. 1994-Dec. 1998, period II : Jan. 1999-Dec. 2002). Results : The limit of viability in fetal infants was markedly lowered from birth weight range of 800-900 g or gestational age range of $26^{+0}-26^{+6}$ weeks in period I to birth weight range of 600-700 g or gestational age range of $24^{+0}-24^{+6}$ weeks in period II. The incidence rates of major complications at the limit of viability were all less than 50% in period II. There was no definite trend toward increased incidence of major complications as birth weight get smaller and gestational age get younger. Conclusion : Our results indicate that at present, fetal infants whose body weight is over 600 g, or whose gestational age is over 24 weeks should be resuscitated vigorously. The risk of major complications at this birth weight or gestational age seems to be not greater than that at a bigger birth weight or an older gestational age.

• Clinical and Experimental Pediatrics
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• v.46 no.3
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• pp.230-235
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• 2003

Purpose : Lower respiratory tract infections in infant and young children are often due to a virus, especially the Respiratory syncytial(RS) virus. Chest X-ray findings in bronchiolitis and bronchopneumonia are different. The radiographic hallmark of bronchiolitis is pulmonary hyperinflation and similar to that of bronchial asthma. Bronchiolitis is predisposed to later development of bronchial asthma. To evaluate the difference of immuno-pathophysiology between bronchiolitis and bronchopneumonia, we measured $IFN-{\gamma}$(Th1 cytokine), IL-5(Th2 cytokine) and ECP. We also investigated whether X-ray findings in infants with viral infected respiratory disease are useful in predicting the development of asthma. Methods : We measured IL-5, ECP, $IFN-{\gamma}$ levels in serum from 21 infants with bronchiolitis and 21 infants with bronchopneumonia and 16 infants without pulmonary viral diseases. Results : IL-5 levels of bronchiolitis and bronchopneumonia were significantly higher than those of the control(P=0.02, P=0.042). IL-5 levels of bronchiolitis were higher than those of bronchopneumonia but there was no significant difference. $IFN-{\gamma}$ levels of bronchopneumonia were higher than those of bronchiolitis but there was no significant difference. ECP levels of bronchiolitis and bronchopneumonia were higher than those of the control but only those of bronchiolitis were significantly higher than those of the control(P=0.045). IL-5 and ECP levels did not show any significant correlation in bronchiolitis, bronchopneumonia and control groups. Conclusion : We cannot prove the distinct differences in serum Th1/Th2 cytokine profiles between bronchiolitis and bronchopneumonia in infants. These results suggest that the different findings on chest X-ray between bronchiolitis and bronchopneumonia could not be a predictor of later development of asthma.