• Pediatric Infection and Vaccine
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• 제28권3호
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• pp.168-172
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• 2021

소아에서 복막뒤감염(retroperitoneal infections)은 복막내감염(intraabdominal infections)에 비해 매우 드물지만 진단이 늦어질 경우 치명적일 수 있다. 저자들은 외부병원에서 급성 신우신염으로 약 3주 간 항균제 치료에도 호전이 없었던 만 10세 여아에서 광범위 베타락탐 분해효소 분비 대장균(extended-spectrum β-lactamase-producing Escherichia coli)에 의한 복막뒤농양 1례를 경험하였기에 보고하는 바이다.

• Journal of Yeungnam Medical Science
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• 제40권2호
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• pp.123-135
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• 2023

Advances in perinatal and pediatric intensive care and recent advances in mechanical ventilation during the last two decades have resulted in an exponential increase in the number of children undergoing home mechanical ventilation (HMV) treatment. Although its efficacy in chronic respiratory failure is well established, HMV in children is more complex than that in adults, and there are more considerations. This review outlines clinical considerations for HMV in children. The goal of HMV in children is not only to correct alveolar hypoventilation but also to maximize development as much as possible. The modes of ventilation and ventilator settings, including ventilation masks, tubing, circuits, humidification, and ventilator parameters, should be tailored to the patient's individual characteristics. To ensure effective HMV, education for the parent and caregiver is important. HMV continues to change the scope of treatment for chronic respiratory failure in children in that it decreases respiratory morbidity and prolongs life spans. Further studies on this topic with larger scale and systemic approach are required to ensure the better outcomes in this population.

• 대한화상학회지
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• 제22권2호
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• pp.25-29
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• 2019

Purpose: This study was performed to investigate the effect of plasma lactate clearance as predictive factor of major burn patients. Methods: A retrospective review was performed on 119 patients from January 2014 to December 2018, who were admitted as severe burn patients to ICU unit. Plasma lactate was measured upon admission to the hospital and 24hrs after admission. And, hospital day, ICU day, TBSA (Total Body Surface Area) and numbers of surgical intervention were collected after admission. Results: Higher lactate clearance showed negative statistical correlation with survival, hospital day, ICU day & number of surgical interventions. Conclusion: In this study, 24hr lactate clearance might be used as predictor of clinical prognosis following major burn injury.

• Korean Journal of Radiology
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• 제20권5호
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• pp.695-708
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• 2019

Atrial fibrillation (AF) is the most common arrhythmia associated with the risk of morbidity and mortality in clinical patients. AF is considered as an arrhythmia type that develops and progresses through close connection with cardiac structural arrhythmogenic substrates. Since the introduction of catheter ablation-mediated electrical isolation of arrhythmogenic substrates, cardiac imaging indicates improved treatment outcome and prognosis with appropriate candidate selection, ablation catheter guidance, and post-ablation follow-up. Currently, cardiac computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging are essential in the case management of AF at both pre-and post-procedural stages of catheter ablation. In this review, we discuss the roles and technical considerations of CCT and CMR imaging in the management of patients with AF undergoing catheter ablation.

• 대한한방내과학회지
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• 제44권2호
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• pp.231-243
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• 2023

Background: Diabetic polyneuropathy is the most common complication in diabetics, occurring in 50% of all cases. About 10-20% of all diabetics are accompanied by neurological pain, showing a tendency to increase with age. Clinical aspects are very diverse, from mild abnormalities on nerve conduction tests to severe abnormalities in all sensory, motor, and autonomic nerves; however, sensory symptoms usually precede motor symptoms. Patients typically express sensory symptoms, such as positive and negative symptoms, which decrease the quality of life and have marked clinical implications, such as increased morbidity and mortality. Although Western medical drugs, such as tricyclic antidepressants, anticonvulsants, and narcotic analgesics, are used for diabetic polyneuropathy, a standard treatment has not been established. Case report: A 65-year-old male with paresthesia and pain due to diabetic polyneuropathy was treated with Uchashinki-hwan, acupuncture, electroacupuncture, moxibustion, and Jungsongouhyul pharmacopuncture for 10 days. We used the Toronto Clinical Neuropathy Scoring System, EuroQol-5 Dimension, and Visual Analog Scale to evaluate symptoms. Subsequently, the Neuropathy Scoring System, EuroQol-5 Dimension, and subjective discomfort improved. Conclusion: The present case report suggests that combined Korean medicine treatment might be an effective treatment for paresthesia and pain with diabetic polyneuropathy. Several follow-up studies should be conducted to clarify the effectiveness of the treatment.

• Clinical and Experimental Pediatrics
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• 제53권6호
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• pp.694-700
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• 2010

Purpose: To assess the validity of individual and combined prognostic effects of severe bronchopulmonary dysplasia (BPD), brain injury, retinopathy of prematurity (ROP), and parenteral nutrition associated cholestasis(PNAC). Methods: We retrospectively analyzed the medical records of 80 extremely low birthweight (ELBW) infants admitted to the neonatal intensive care unit (NICU) of the Severance Children's Hospital, and who survived to a postmenstrual age of 36 weeks. We analyzed the relationship between 4 neonatal morbidities (severe BPD, severe brain injury, severe ROP, and severe PNAC) and poor outcome. Poor outcome indicated death after a postmenstrual age of 36 weeks or survival with neurosensory impairment (cerebral palsy, delayed development, hearing loss, or blindness) between 18 and 24 months of corrected age. Results: Each neonatal morbidity correlated with poor outcome on univariate analysis. Multiple logistic regression analysis revealed that the odds ratios (OR) were 4.9 (95% confidence interval [CI], 1.0-22.6; $P$=0.044) for severe BPD, 13.2 (3.0-57.3; $P$<.001) for severe brain injury, 5.3 (1.6-18.1; $P$=0.007) for severe ROP, and 3.4 (0.5-22.7; $P$=0.215) for severe PNAC. Severe BPD, brain injury, and ROP were significantly correlated with poor outcome, but not severe PNAC. By increasing the morbidity count, the rate of poor outcome was significantly increased (OR 5.2; 95% CI, 2.2-11.9; $P$<.001). In infants free of the above-mentioned morbidities, the rate of poor outcome was 9%, while the corresponding rates in infants with 1, 2, and more than 3 neonatal morbidities were 46%, 69%, and 100%, respectively. Conclusion: In ELBW infants 3 common neonatal mornidifies, severe BPD, brain injury and ROP, strongly predicts the risk of poor outcome.

• Journal of Chest Surgery
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• 제31권11호
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• pp.1043-1048
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• 1998

연구배경 : 허혈성심질환 환자가 증가함에 따라 저자들은 관상동맥우회술을 시행한 환자의 치료 및 관리에 도움이 되고자 조기 성적 및 합병증 발생에 영향을 줄 수 있는 위험인자에 대하여 임상분석을 하였다. 재료 및 방법 : 1996년 6월부터 1998년 2월까지 관상동맥우회술을 시행받은 환자 42명의 연령, 성별, 술전 심박구출률, Canadian heart classification, 허혈성심장질환의 위험 인자, 술전 관상동맥 조영술 소견, 내흉동맥 사용 유무, 이식 혈관 수, 체외순환시간 등과 합병증 발생과의 상관관계에 대하여 분석하였고 생존 및 사망률, 사망원인에 대하여 조사하였다. 결과 : 술후 합병증은 17명에서 발생하였다. 합병증이 발생한 군의 평균연령은 61$\pm$11.9세로 발생하지 않은 군의 평균 연령 51세$\pm$10.5에 비해 유의하게 높았다(p=0.004). 체외순환 시간은 합병증이 발생한 군은 198$\pm$42.5분, 발생하지 않은 군은 158$\pm$47.4분으로 유의한 차이를 보였다(p=0.008). 그 외의 인자들은 통계학상 유의한 차이가 없었다. 평균 추적 조사 기간은 12.5개월이었으며 수술사망을 제외한 모든 환자에서 생존이 확인되었다. 수술사망은 2명(4.7%)이었고 그 중 1명은 대동맥판막치환술을 같이 시행받았던 환자로 술후 다발성 장기 기능부전으로 사망했고 또 다른 1명은 술후 폐렴, 창상감염 및 패혈증으로 사망하였다. 결론 : 본 연구의 결과 환자의 연령과 체외순환시간이 관상동맥우회술후 합병증 발생에 위험인자로 작용하며, 그 외의 인자는 관계가 없는 것으로 나타났다.

• 중환자간호학회지
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• 제13권2호
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• pp.12-23
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• 2020

Purpose : This study aimed to evaluate the clinical outcomes of direct interhospital transfers (IHTs) of patients with acute aortic syndrome (AAS) led by advanced practice nurses (APNs). Methods : From September 2014 to June 2017, the study retrospectively investigated 183 patients with AAS who were transferred to a high-volume tertiary hospital. Results : One hundred forty-eight (81%) patients were admitted through direct IHTs, and 35 (19%) patients were admitted through non-direct IHTs. The direct IHT group had a significantly shorter time from symptom onset to hospital arrival than the non-direct IHT group (11.4 vs. 32.1 h, p=.043). There were no significant differences in other clinical outcomes, such as peri-transfer status, mortality, hospital length of stay, and readmission, between the two groups. In the direct IHT group, 55% of transfers were led by APNs. There was no significant difference in outcomes between APN- and physician-led transfers. Conclusions : Implementation of direct IHTs markedly shortened the time from symptom onset to hospital arrival in patients with AAS. Finally, direct IHTs can potentially improve the outcomes of patients with AAS, a condition with time-dependent mortality and morbidity. In addition, APNs can effectively lead the direct IHT of patients with AAS.

• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.175-183
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• 2015

Objective : Intracranial ruptured vertebral artery dissecting aneurysms (VADAns) are associated with high morbidity and mortality when left untreated due to the high likelihood of rebleeding. The present study aimed to establish an endovascular therapeutic strategy that focuses specifically on the angioarchitecture of ruptured VADAns. Methods : Twenty-three patients with ruptured VADAn received endovascular treatment (EVT) over 7 years. The patient group included 14 women (60.9%) and 9 men (39.1%) between the ages of 39 and 72 years (mean age 54.2 years). Clinical data and radiologic findings were retrospectively analyzed. Results : Four patients had aneurysms on the dominant vertebral artery. Fourteen (61%) aneurysms were located distal to the posterior inferior cerebellar artery (PICA). Six (26%) patients had an extracranial origin of the PICA on the ruptured VA, and 2 patients (9%) had bilateral VADAns. Eighteen patients (78%) were treated with internal coil trapping. Two patients (9%) required an adjunctive bypass procedure. Seven patients (30%) required stent-supported endovascular procedures. Two patients experienced intra-procedural rupture during EVT, one of which was associated with a focal medullary infarction. Two patients (9%) exhibited recanalization of the VADAn during follow-up, which required additional coiling. No recurrent hemorrhage was observed during the follow-up period. Conclusion : EVT of ruptured VADAns based on angioarchitecture is a feasible and effective armamentarium to prevent fatal hemorrhage recurrence with an acceptable low risk of procedural complications. Clinical outcomes depend mainly on the pre-procedural clinical state of the patient. Radiologic follow-up is necessary to prevent hemorrhage recurrence after EVT.

• Clinical and Experimental Pediatrics
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• 제56권1호
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• pp.19-25
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• 2013

Purpose: Childhood obesity is associated with nonalcoholic fatty liver disease (NAFLD), and it has become one of the most common causes of childhood chronic liver diseases which significant as a cause of liver related mortality and morbidity in children in the United States. The development of simpler and easier clinical indices for medical practice is needed to identify advanced hepatic fibrosis in childhood NAFLD instead of invasive method like liver biopsy. FibroScan and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) have been proposed as a simple and noninvasive predictor to evaluate hepatic fibrosis in several liver diseases. APRI could be a good alternative to detect pathologic change in childhood NAFLD. The purpose of this study is to validate the efficacy of APRI for assessing hepatic fibrosis in childhood NAFLD based on FibroScan. Methods: This study included 23 children with NAFLD who underwent FibroScan. Clinical, laboratory and radiological evaluation including APRI was performed. To confirm the result of this study, 6 patients received liver biopsy. Results: Factors associated with hepatic fibrosis (stiffness measurement >5.9 kPa Fibroscan) were triglyceride, AST, alanine aminotransferase, platelet count, APRI and collagen IV. In multivariate analysis, APRI were correlated with hepatic fibrosis (>5.9 kPa). In receiver operating characteristics curve, APRI of meaningful fibrosis (cutoff value, 0.4669; area under the receiver operating characteristics, 0.875) presented sensitivity of 94%, specificity of 66%, positive predictive value of 94%, and negative predictive value of 64%. Conclusion: APRI might be a noninvasive, simple, and readily available method for medical practice to predict hepatic fibrosis of childhood NAFLD.