• Journal of the Korean Society of Radiology
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• v.83 no.1
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• pp.138-148
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• 2022

Purpose This study evaluated the rates and annual trends of pediatric CT scans in South Korea using a nationwide population-based database. Materials and Methods Data regarding pediatric CT scan usage between 2012 and 2017 were retrieved from the health insurance review and assessment service. Data on the age, sex, diagnosis, and the anatomical area of involved patients were also extracted. Results A total of 576376 CT examinations were performed among 58527528 children aged below 18 years (9.8 scans/1000 children), and the number of CT examinations per 1000 children was noted to have increased by 23.2% from 9.0 in 2012 to 11.0 in 2017. Specifically, the number of CT examinations increased by 32.9% for the 6-12 years of age group (7.4/1000 to 9.8/1000) and by 34.0% for the 13-18 years of age group (11.4/1000 to 15.3/1000). Moreover, majority of the CT scans were limited to the head (39.1%), followed by the extremities (32.5%) and the abdomen (13.7%). Notably, the number of extremity CT scans increased by 83.6% (2.3/1000 to 4.2/1000), and its proportion as compared to other scans increased from 25.3% to 37.7%. Conclusion CT scans in the pediatric population increased continuously from 2012 to 2017 at an annual rate of 4.4%. Therefore, physicians should balance the benefits of CT with its potential harms from associated radiation exposure in pediatric patients.

• The Journal of the Convergence on Culture Technology
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• v.10 no.4
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• pp.235-240
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• 2024

We designed this study because it is necessary to take health care from middle age for to healthy old age. The purpose of this study was to confirm the effect of middle-aged women on the walking mechanism by applying an exercise program that can achieve the maximum effect through simple exercise regardless of time and place. A total of 20 subjects were selected from middle-aged women aged 45 years or older, with 10 calf-enhancing exercise groups and 10 control groups. As a result of comparing before and after exercise in the calf-enhancing exercise group, the step length left and right, and double support, step time, and speed were improved. As a result of comparing the walking mechanisms of the calf-enhancing exercise group and the non-exercise group after exercise, the step length left and right, and step time left and right were improved. The positive effect of the walking mechanism was shown through the calf-enhancing exercise regardless of time and place. In particular, it is judged that the stride was widened, resulting in an increase in the speed of walking due to the strength of the lower extremities and the shortening of the one-foot support section, resulting in meaningful results. In future studies, it is considered desirable to present measurement data for each life cycle by evaluating all ages, such as adolescents and the elderly, and to provide it as basic data for causing social problems due to lack of normal exercise.

• Clinical and Experimental Pediatrics
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• v.50 no.11
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• pp.1078-1084
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• 2007

Purpose : The prevalence of childhood obesity has doubled over the last 30 years. Obesity-associated sequelae in the vasculature begins in the early stages of life. The purpose of this study was to investigate how pulse wave velocity (PWV) and ankle brachial index (ABI) change with height, weight and body mass index (BMI) in obese adolescents. Methods : Seventy-nine obese adolescents (group 1: $85th{\leq}BMI<95th$ percentile, n=40; group 2 ($BMI{\geq}95th$ percentile, n=39) were included. The control group(group 3) included 99 healthy adolescents. Brachial- ankle (ba) PWV and ABI were estimated with blood pressure from four extremities. Heart rate (HR), and pre-ejection period/ejection time (PEP/ET) were also estimated. BMI was calculated from individual height and weight. Linear regression analysis was performed to evaluate the correlations between BMI and PWV. Results : Blood pressure and baPWV were significantly higher in group 2, compared to either group 1 or group 3. However, there was no significant difference in ABI, HR and PEP/ET between the groups. PWV showed linear correlation with both BMI and body weight. Conclusion : Obesity was associated with higher arterial stiffness in adolescents, which was demonstrated by an increase in PWV. There was no significant correlation between obesity and ABI.

• Journal of Life Science
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• v.20 no.4
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• pp.549-554
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• 2010

Increased external rotation and decreased internal rotation have been noted to occur progressively in the throwing shoulders of baseball pitchers. The purpose of this study was to provide descriptive data for terminal range eccentric antagonist/concentric agonist shoulder muscle strength in collegiate baseball pitchers with humeral head retroversion diagnosed through MRI. The dominant and non-dominant shoulders of 9 asymptomatic baseball pitchers were tested through a range of 20 degrees of external rotation to 90 degrees of internal rotation using the Biodex system 3 isokinetic dynamometer at speeds of $90^{\circ}/s$ and $180^{\circ}/s$. Differences between the dominant and non-dominant shoulders were assessed using the paired samples t-test. Total range of motion, measured at $90^{\circ}$ of glenohumeral abduction, was $180.1^{\circ}$ for dominant shoulders and $183.7^{\circ}$ for non-dominant shoulders. Humeral head retroversion measured $47.6{\pm}6.1^{\circ}$ in dominant and $37.8{\pm}5.3^{\circ}$ in non-dominant extremities. The mean internal rotator concentric contraction (IR-Con) showed a significant difference compared to $31.5{\pm}5.1$ (Nm) in dominant and $38.7{\pm}5.2$ (Nm) in non-dominant shoulders at $180^{\circ}/s$ (p<0.05). The mean external rotator eccentric contraction (ER-Ecc) showed a significant difference compared to $20.3{\pm}4.7$ (Nm) in dominant and $25.1{\pm}3.7$ (Nm) in non-dominant shoulders at $90^{\circ}/s$ (p<0.05). There is a pattern of increased external rotation and decreased internal rotation in the dominant extremity that significantly correlates with an increase in humeral retroversion.

• Pediatric Infection and Vaccine
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• v.14 no.1
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• pp.62-68
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• 2007

Purpose : The cause and pathogenesis of Henoch-Sch$\ddot{o}$nlein purpura (HSP) are unknown, but recently the hypothesis that immunoglobulin A may have an important role in the pathogenesis of HSP is being published and HSP associated with mycoplasma infection has been also reported. The aim of this study is to discover relation between HSP and mycoplsma infection. Methods : From Jan. 2002 to Dec. 2005, we retrospectively evaluated 98 children who were diagnosed as HSP at Ilsan Paik Hospital. 84 patients were not associated with mycoplasma infection (group A) and 14 patients were associated with mycoplasma infection (group B). We compared both groups about clinical features. Results : The ratio of male to female patients in group A and B were 1.21:1 and 1.80:1. The number of patients in group A was most in November and December, and in group B was most in November. All patients had non-thrombocytopenic purpura concentrated on the buttocks and lower extremities and joint involvement was most common on the feet and ankle in both groups. 57 (67.9%) cases in group A and 9 (64.3%) cases in group B complained of abdominal pain. And 21 (25.0%) cases in group A and 5 (35.7%) cases in group B had nephritis. Elevated mycoplasma antibody titer (${\geq}1:320$) or 4 fold-rise were noted in 14 of 98 patients (14.3%). In this study, there was one child with HSP preceded by typical mycoplasma pneumonia (mycoplasma antibody titer 1:1280). Conclusion : In this study, elevated mycoplasma antibody titer (${\geq}1:320$) or 4 fold-rise were noted in 14 of 98 patients and the difference of clinical features between group A and B was not specific. The role of mycoplasma infection in the etiology of HSP may have been implicated, so the association with mycoplasma infection should have to be proved by further controlled studies.

• Journal of Korean Academy of Nursing
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• v.1 no.1
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• pp.64-76
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• 1970

This report will present a clinical and statistical analysis of 210 case of Ectopic pregnancies who were treated at the Department of Obstetrics and Gynecology at Chung Nam Medical Center from January, 1966 to March, 1970. The results obtained are as follows; 1. The total number of Ectopic pregnancies was 8.22%. 2. The occurrence of Ectopic pregnancy was high in June(13.81%), low in October(2.98%). There was a higher occurrence of Ectopic pregnancy in the summer than in the winter. 3. The average age of all patients was 33.25 years. The most frequent age for this type of pregnancy was 31-35 years (32.86%) . The youngest patient was 18 years old and the oldest was 50. 4. Multipara occurred in 82.38% of the cases; Mulipara in 17. 62% and the occurrence of primipara was especially high, 20.95%. 5. 48.09% of the women had previously experienced normal deliveries; 42.8% had received artificial abortions and 5.23% had experienced spontaneous abortions. 3.8% had a previous history of Ectopic pregnancy. It was found that the occurrence of Ectopic pregnancy was more frequent in those women who had a D & C in the Past. 6. The average length of infertility was 21.7 months. The shortest length was 60 days; longest period of infertility was 19 years. 7. The occurrence of Ectopic pregnancy is higher (29.27%) in patient who have experienced only one previous D & C. The total number of patients who received a D & C was 58.57%. 3. Ectopic symptoms appeared during the first 4.7 weeks (mean) and most frequently occurred between the 5th and 6th weeks (48.57%) of pregnancy. The Symptoms were: -99.04% complained of lower abdominal pains. -80.95% experienced abnormal uttering bleeding. -42.38% experienced bleeding before the occurrence of pain. -18.57% experienced pain before the occurrence of bleeding. -8.57% experienced both pain and bleeding. -7.62% experienced only bleeding. -22.86% experienced only pain. 9. In-77.62% of the cases the annexal mass palpated. 91.42% complained of abdominal tenderness. 42.38% complained of pain when the cervix was examined. 10. Culdocentesis was performed in 86.19% of the cases. In 92.82% of the cases the presence of an Ectopic pregnancy was accurately diagnosed 11. 71.90% of the Ectopic pregnancies occurred in the ampule portion of the ovarian tube, of the total number of gestations, 40.95% were tubal abortions and 59.05% were ruptured. The ruptured group occurred more frequently in the islamic portion and interstitial portion of the tube than the aborted group. The aborted group occurred more frequently in the fimbrial extremities of the tube. 12. The blood pressure (systolic) was noted at 119-80mmHg in 81.89% of the total cases. Hemoglobin value was noted at over 8gm/㎗ in 58.57% of the cases. The average blood transfusion was 2.3 pints. 13. In 52.86% of the Ectopic pregnancies the right side of the ovarian tube was affected. The left side of the tube was affected in 47.14% of the cases. 14. 3.33% of the patients were not given an accurate diagnosis. 15. The kinds of operation performed were as follows; Salpingectomy, 41.43%; Adnectomy, 38.57% and Adnectomy with total hysterectomy, 19.05%. 16. The patient mortality rate was significantly small; only 1 case out of 210 died. This patient most likely had a profuse hemorrhage because of a ruptured tube before her admission to the hospital. 17. The patients personal feelings and attitudes must be treated with care. Particularly patients who are concerned about vaginal bleeding or the impossibility of another pregnancy.

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1040-1050
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• 1997

Pulmonary rehabilitation has been known to improve dyspnea and exercise tolerance in patients with chronic lung disease, although it does not improve pulmonary function. The mechanism of this improvement is not clearly explained till now; however some authors suggested that the improvement in the skeletal muscle metabolism after the rehabilitation could be a possible mechanism. The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation which causes early activation of anaerobic glycolysis and excess lactate production with exercise. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the improvement in the exercise tolerance after the rehabilitation, noninvasive $^{31}P$ magnetic resonance spectroscopy(MRS) of the forearm flexor muscle was performed before and after the exercise training in nine patients with chronic lung disease who have undertaken intensive pulmonary rehabilitation for 6 weeks. 31p MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntary contraction(MVC) force of the muscle was measured before the isometric exercise, and then 30% of MVC force was constantly loaded to each patient during the isometric exercise. After the exercise training, exercise endurance of upper and lower extremities and 6 minute walking distance were significantly increased(p<0.05). There were no differences of baseline intracellular pH (pHi) and inorganic phosphate/phosphocreatine(Pi/PCr). After rehabilitation pHi at the exercise and the exhaustion state showed a significant increase($6.91{\pm}0.1$ to $6.99{\pm}0.1$ and $6.76{\pm}0.2$ to $6.84{\pm}0.2$ respectively, p<0.05). Pi/PCr at the exercise and the recovery rate of pHi and Pi/PCr did not show significant differences. These results suggest that the delayed intracellular acidosis of skeletal muscle may contribute to the improvement of exercise endurance after pulmonary rehabilitation.

• Neonatal Medicine
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• v.18 no.2
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• pp.288-292
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• 2011

Purpose: The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection has increased in children and in neonates, and is particularly associated with frequent use of central venous catheter in very low birth weight (VLBW) infants. It is known that the morbidity and mortality of MRSA infection are low in neonates, as compared with adults. The objective of this study was to examine the difference in clinical characteristics between VLBW infants that survived and those that did not, a catheter-related bloodstream infection (CRBSI) of MRSA. Methods: Thirty-four VLBW infants had laboratory-confirmed bloodstream infection with S. aureus. We examined the incidence, mortality and morbidity of CRBSI, and predictive factors associated with mortality. Results: Twenty-six infants had same pathogen (24 MRSA, 2 Methicillin-sensitive Staphylococcus aureus) in the blood and in the catheter tip. Eight infants (25.8%) died in the CRBSI and they all had MRSA blood infections. Sex ratio, gestational age, duration between blood collection and identification of pathogens, and WBC and platelet count were not significantly different between patients that died from and patients that survived CRBSI of MRSA. C-reactive protein (CRP) was significantly higher in VLBW infants that died. Mean age of onset and hospital day was earlier (9.1${\pm}$6.6 vs. 26.9${\pm}$20.2; P=0.005) and shorter for patients that died (10.1${\pm}$7.0 vs. 73.0${\pm}$32.4; P=0.000). Two survivors had complications of pyogenic arthritis of the lower extremities and soft tissue infection, respectively. Conclusion: Mortality of CRBSI was likely to be high in VLBW infants and might be anticipated by CRP and early onset of disease.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.24-34
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• 1996

There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

• Clinical and Experimental Pediatrics
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• v.48 no.1
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• pp.75-80
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• 2005

Purpose : Internal tibial torsion is prevalent in East Asian countries such as Korea and Japan, where sitting on the floor is common behavior. Internal tibial torsion or excessive lateral tibial torsion may cause esthetical, functional, or psychological problems and also may induce degenerative arthritis in older age. The purpose of this study is to measure the tibial torsion in children of the Jeju area. Methods : Tibial torsion was measured in 1,042 lower extremities of 521 children from one to 12 years of age. The values of transmalleolar angles were analyzed for each age group divided by 6 months. Quadratic and linear regression models were used to fit patterns of changes in mean values of transmalleolar angles. The age at seven, which provides the highest coefficient of determination for quadratic regression analysis, was used as a cut-off point to fit different statistical models. Results : The mean transmalleolar angle was $0.10{\pm}5.79^{\circ}$ in all children,$ 0.90{\pm}5.49^{\circ}$ in males, and $-0.80{\pm}5.97^{\circ}$ in females. The value was $4.25{\pm}4.04$ in 1 year of age, gradually decreased to the lowest level of $-1.98^{\circ}$ in four years and seven months of age, increased again with age until it reached $0.67{\pm}1.10^{\circ}$ at seven years of age, and stayed at that level thereafter. Conclusion : Internal tibial torsion in infancy is known to correct spontaneously in the normal developing process. But in this study, the mean transmalleolar angle in children of Jeju area annually decreased after one year of age; to the lowest angle at four years and seven months of age; increased again gradually to the age of seven; and persisted in that level, about $10^{\circ}$ less than western children, not correcting further thereafter. These findings suggest tibial torsion might be caused by lifestyle, especially sitting on feet. To prevent abnormalities of joints and gaits, early diagnosis of tibial torsion in childhood and posture correction or early treatment when needed, seems to be necessary.