• Pediatric Infection and Vaccine
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• v.27 no.2
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• pp.102-110
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• 2020

Purpose: This study aimed to investigate the clinical characteristics of human parechovirus (HPeV) infection in sepsis-like syndrome in infants aged under 3 months. Methods: Medical records of infants aged under 3 months with sepsis-like symptoms who were admitted between July 1, 2018 and August 31, 2018 were reviewed. A multiplex reverse transcription-polymerase chain reaction panel test was performed on the cerebrospinal fluid (CSF). Thirty-nine enrolled infants were categorized into three groups: 11 in group 1 (HPeV detected in the CSF), 13 in group 2 (enterovirus detected in the CSF), and 15 in group 3 (no virus detected in the CSF). Results: Compared with groups 2 and 3, a higher proportion of group 1 had tachycardia, tachypnea, apnea, and hypotension (P<0.05). A significantly lower white blood cell (WBC) count was noted in group 1 than in groups 2 and 3 (5,622±2,355/μL, 9,397±2,282/μL, and 12,312±7,452/μL, respectively; P=0.005). The CSF WBC count was lower in group 1 than in groups 2 and 3 (0.9±1.7/μL, 85.1±163.6/μL, and 3.7±6.9/μL, respectively; P=0.068). The proportion of patients requiring inotrope support (36.6% vs. 0% and 6.6%), mechanical ventilation (18.1% vs. 0% and 0%), and high flow nasal cannula (45.4% vs. 15.3% and 6.6%) was higher in group 1 than in groups 2 and 3. All patients recovered completely without complications. Conclusions: HPeV infection shows a severe clinical course and can cause a severe sepsis-like syndrome in infants aged under 3 months. Early diagnosis and proper treatment of HPeV infection are required.

• Neonatal Medicine
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• v.17 no.2
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• pp.224-231
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• 2010

Purpose: Hospital readmissions have recently increased due to early hospital discharge and increased trends in breast-feeding. Neonatal hyperbilirubinemia can lead to fatal permanent neurological sequelae without appropriate management. Early detection and intervention are critical. We evaluated the clinical features, risk factors, and brain MRI findings of Korean newborns with idiopathic nonhemolytic hyperbilirubinemia to determine the optimal management policy. Methods: A retrospective review of the medical records of 79 newborns with idiopathic nonhemolytic hyperbilirubinemia was performed at the NICU of the Kyungpook National University Hospital from January 2006 to September 2009. All patients were 35 or more weeks of gestation, and their peak level of serum total bilirubin was more than 20 mg/dL. Results: The mean gestational age was $38^{+3}{\pm}1^{+4}$ weeks, and the mean age on admission was 8.8$\pm$4.0 days. The mean body weight (3,105$\pm$479 g) was decreased by 2.8$\pm$6.4 percent compared to the mean birth weight (3,174$\pm$406 g). There were no statistically significant differences for the peak serum bilirubin level or the duration and effects of phototherapy between the patients with and without risk factors, which included: breastfeeding, cephalohematoma, subdural hemorrhage, and/or ABO incompatibility. Patients were grouped according to change of body weight. Group I consisted of patients that gained weight compared to birth weight, and group II of patients that lost weight compared to birth weight. There were significant differences in the peak serum total bilirubin level between the two groups. Thirty nine patients had brain MRI evaluation; 21 patients had bilateral symmetric signal intensity increases in the globus pallidus compared to adjacent corticospinal tract and putamen on T1-weighted images. Conclusion: Bilirubin encephalopathy is preventable with early screening and proper management. Parents require instruction on feeding practices and follow-up to prevent complications from idiopathic nonhemolytic hyperbilirubinemia.

• Childhood Kidney Diseases
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• v.6 no.2
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• pp.209-217
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• 2002

Purpose : Corticosteroid has been used as the mainstay therapy of childhood NS. But SIO is one of the serious complications of long-term steroid therapy, especially in growing children. Recently calcium, calcitonin, PTH, vitamin D and bisphosphonate has been used to treat or prevent SIO in adult, which is rare in children with NS. We studied the effect of $1{\alpha}-(OH)D_3$ and Pamidronate on SIO using dual energy X-ray absorptiometry (DEXA). Patients and methods : We studied thirty patients who admitted in the Dept. of Pediatrics of Kyung Hee Medical Hospital with NS. All patients was received longterm steroid therapy. There was no history of bone, liver, or endocrine disease. The samples, serum protein, albumin, BUN, creatinine, calcium, phosphorus, and BMD were obtained before and the six months after the dose of $1{\alpha}-(OH)D_3$ and Pamidronate, respectively Results : The mean age was $6.9{\pm}3.3\;and\;6.5{\pm}2.5$ years old. The mean duration of steroid therapy was $28.8{\pm}1.8\;and\;27.6{\pm}1.0$ months. The changes of serum protein, albumin, BUN, creatinine, calcium and phosphorus level between pre-treatment and post-treatment did not show statistical significance in both $1{\alpha}-(OH)D_3$ and Pamidronate treatment group. However, BMD was increased in both from $0.472{\pm}0.12\;and\;0.457{\pm}0.10\;g/cm^2\;to\;0.533{\pm}0.12$ and $0.529{\pm}0.09\;g/cm^2$ after treatment. (P<0.05) Conclusion : Both $1{\alpha}-(OH)D_3$ and Pamidronate appears to be effective in treating and preventing SIO in children with nephrotic syndrome requiring long-term steroid therapy.

• Pediatric Infection and Vaccine
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• v.5 no.2
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• pp.258-266
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• 1998

Purpose : Cases of adenoviral penumonia with rapidly progressive clinical course were experienced. We reviewed these patients in viewpoint of clinical manifestation and adenoviral serotypes. Methods : Culture and indirect immunofluorescence for respiratory viruses including respiratory syncytial virus, influenza virus, parainfluenza virus, adenovirus was done with nasopharyngeal aspirates from patients who admitted due to respiratory infections in Fatima Hospital, Masan from Nov. 1996 to Jul. 1997. Cultured adenovirus was serotyped by both neutralization and hemagglutination inhibition test. Medical records were reviewed for 5 patients with respiratory failure from adenovirus was isolated and serotyped. Results : The total number of examined patients was 460 patients. We isolated respiratory viruses in 143(30.9%) patients. Adenovirus was isolated from 66 out of 143(46.2%) patients. During Jan 1997 to May 1997, five patients with ages of 18 days to 11 months who were infected by adenovirus and had high fever with dyspnea and required assisted mechanical ventilation. One patients discharged against doctor's advice then died. Two of four patients had complications of disseminated intravascular coagulation; two had bronchiolitis obliterans. Two isolates were serotype 7, and one was serotype 5, and two were untyped. Conclusion : Severe pneumonia caused by serotype 7 continued to occur in 1997 following the epidemic in 1996, and severe pneumonia may also be caused by serotype 5 and other serotypes.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.799-806
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• 2002

In spite of the establishment of chemotherapy and the gradual decrease in prevalence, pulmonary tuberculosis is still mainly treated with an operation. Through analyzing and examining some cases of surgical treatment, we hope to provide some help in treating of pulmonary tuberculosis in the future. Material and Method: By comparing four journals previously published in our department with 144 cases of lung surgery during ten years from January of 1991 to December of 2000 performed by the department of thoracic and cardiovascular surgery of the National Medical Center, we analyzed and reviewed the most recent trends and the results of the surgical treatment. Annual frequency of the operation, distribution of age, examination of sputum, adaptability and types of techniques, complications, and results of the postoperative follow-up were used as methods. Result: It was found that the annual frequency of operations had decreased. The ratio of men to women, 2:1 indicates that there are more incidences in men. Aging of patients could be speculated by the .results that the decrease in the incidence rate in the 20s age range and increase rate in the 50s age range. The range of preoperative lesions belonged mostly to far advanced and moderately advanced tuberculosis. By monitoring the period of use in preoperative antituberculosis drugs, cases for more than 3 years remarkably increased from 16.0 % to 55.6 %. The positive reactive rate for preoperative sputum examinations were drastically decreased from 91 % to 27 %. Total pulmonary destruction and partial destruction were the most common cases in terms of adaptability to the operations and there were significant increases in forming empyema accompanied by parenchymal lesions from 4.0 % to 20.1 %. Pneumonectomy and pulmonary lobectomy were the major type of operations. Especially, there were increases in the incident rate of empyema and recurrence of tuberculosis resulted. Post operative follow-up indicates that the rate of complete recovery was more than 70 % and the rate of gradual increase in treating with persistent antituberculosis drug was from 5.8 % to 18.0 %. Conclusion: In recent cases, there is an increasing number of patients showing tolerance to chemotherapy. Patients with pleural tuberculosis and severe lesions were typically increased. It is important to accurately analyze those complaints accurately that are mostly difficult to be treated medically. Surgical treatment is strongly recommended Before multiple drug resistance occurs.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.827-832
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• 2004

Background: The significance of MIDCAB is emerging topics recently as OPCAB is going to be universalized, and long-term outcome of bypass graft surgery was proved to be more excellent than balloon dilation or stent insertion. We report our MIDCAB results in 73 patients in the last three years. Material and Method: Retrospective analysis of medical records was done from November 1, 2000 through November 31, 2003. There were 47 males and 26 females ranging in age from 31 years to 79 years (average $61.3\pm9.8$ years). Observation periods after operative procedures were 10 to 1238 days (average $763\pm319.8$ days). Left longitudinal parasternal incision as a standard procedure was done to approach the heart after dissection of the left internal thoracic artery by partial or total resection of 3rd to 5th ribs. Result: Of those patients, 46 patients were transferred to ICU after extubation at operation room and 58 patients were extubated within 3 hours after operation. Average ICU staying periods was $26.8\pm11.5$ hours. Follow-up angiography during admission was done in 36 patients and showed 100% patency. Only one patient died on the 10$^{th}$ post operative day because of sudden CVA. Complications included wound problems in 4 patients, and constructing pericardial window using thoracoscopy due to continuous pericardial effusion in 1. Permanent pacemaker was inserted in one patient owing to sick sinus syndrome. In one patient with recurrence of angina 8 months after operation, stenosis at anastomic site was found and improved with balloon dilatation. Conclusion: We were satisfied with our results of MIDCAB in single and multi-vessel coronary artery disease. These results have made the cardiologists tried to operate positively and we expect widening operative indications including hybrid revascularization.

• Journal of Chest Surgery
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• v.34 no.9
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• pp.672-679
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• 2001

Background: Surgical correction of partial anomalous pulmonary venous connection to the superior vena cava has been associated with postoperative venous obstruction and sinus node dysfunction. In this paper we describe our current approach and its short-term results. Material and Method: Between April 1999 and January 2000, 5 consecutive patients, ranging from 2 months to 66 years old, underwent corrective operation for partial anomalous pulmonary venous connection to the superior vena cava at Sejong General Hospital and Daegu Catholic University Medical Center. Surgical correction involved diversion of the pulmonary venous drainage to the left atrium using a right atrial flap(2 patients) or prosthetic patch(3 patients) with division of the superior vena cava superior to the restore site of the pulmonary veins and reimplantation on the right atrial appendage to restore systemic venous drainage. Result: All patients were discharged between postoperative day 9 and 15 without complications. One Russian boy returned to his country, therefore, he was lost to follow-up after discharge. Remaining 4 patients were asymptomatic and in normal regular sinus rhythm at a mean follow-up of 17.75$\pm$4.27 months. Follow-up echocardiographic study (range, 12 to 24 months) revealed no incidence of narrowing of the venous pathways or of residual shunt. Conclusion: Our current approach is relatively simple and reproducible in achieving unobstructive pulmonay venous and SVC pathways. By avoiding incision across the cavoatrial junction, surgical injury to the sinus node and its artery may be minimized. The presented surgical technique can be safely and effectively applied to the selected patients.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.373-378
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• 1999

Background: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. Material and Method: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. Result: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. Conclusion: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.

• Journal of agricultural medicine and community health
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• v.20 no.1
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• pp.39-49
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• 1995

This study was attempted to investigate the acceptive status of 428 persons who had taken the vasectomy and the tubal ligation and the intra-uterine device(IUD, copper-T). It defined the complications after the contraceptive procedures and the effects of the supporting of the government for contraception. The target population was identified from the list of the 105 females taken tubal ligation, and 109 males vasectomized, 214 IUD acceptors covered by Gumi Health Center from January 1990 to December 1992. Data was collected from the target population by the questionnaire and medical records between March 1 and April 30, 1993. Among the study subjects, 56.0% of vasectomized males was between 30 and 34 years of age and the highest percentages of tubal ligation and IUD acceptors were between 25 and 29 years of age. The highest percentage of occupation of vasectomized males was officials and that of tubal ligation and IUD acceptors was in no occupational status. 81.2% of respondents were more than high school in educational level, educational level of vasectomized males was more higher than that of females. The percentage contraceptive acceptors with one or two children was 90.8% for vasectomized males, 80.1% for females with tubal ligation, and 93.9% for IUD acceptors. The most people accepted the contraception as they felt the need rather than other's persuasion. The major reasons of contraception were having the wanted children and alleviating the economic burden for the raising and the educating their children. Among the vasectomized males, 11.0% complained the side reaction and the most common symptoms were the inflammation around the wound and sexual declination. Among the tubal ligation females, 46.7% complained the side reaction and the most common symptoms were vaginal discharge, the menorrhagia, back pain and lethargy. The IUD acceptors were similar to them. The regretting rate of tubal ligation and the IUD acceptors was higher than the vasectomized males. The major reason of their regretting was the side reaction in the tubal ligation and the IUD. But the vasectomized males had the insecurity that they couldn't have their own children any more, and sexual declination. The main reason of the females accepted the tubal ligation and the IUD were the fears about toward induced abortion. The most contraceptive acceptors(83.2%) wanted to be offered by the government, but if they pay the expense in their own money, they would accept the contraception in 86.9%.

• Journal of Gastric Cancer
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• v.7 no.2
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• pp.82-87
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• 2007

Purpose: In gastric cancer patients with gastric outlet obstruction, there are several complications such as malnutrition and vomiting. Palliative enteral stenting is a less invasive procedure as compared with a gastrojejunostomy. The aim of this study was to determine whether there was a significant difference between patients that undergone palliative enteral slanting and patients that had received a bypass gastrojejunostomy. Materials and Methods: One hundred patients underwent palliative entering stenting and 3f patients were subjected to a surgical bypass gastrojejunostomy. We reviewed the medical records of the patients with gastric outlet obstruction secondary to far advanced gastric cancer that were diagnosed using a gastrofibroscope, UGI and abdominal CT, and were admitted to our institution between January 2000 and August 2006. The outcome of stent placement for gastric outlet obstruction was compared with palliative gastrojejunostomy during the same period. We excluded patients with recurrent gastric cancer and double cancer from this study. Results: There were significant differences between the group of patients that underwent slanting and the group of patients that received a gastrojejunostomy regarding the age of patients ($67{\pm}12$ vs. $57{\pm}9$, P<0.001) but not between the sex of the patients (M : F, 2 : 1 vs. 2 :1, P=0.637). The most common complication of stenting was tumor ingrowth (16/100, 16%) and the second most common complication was stent migration (14/100). Failure of the procedure occurred in only three patients. Twenty-three patients underwent re-slanting and one patient required open conversion with a gastrojejunostomy. The median time to the first meal was $4{\pm}2$ days in the stent group of patients and $6{\pm}2$ days in the gastrojejunostomy group of patients (P=0.001). The median postoperative hospital stays were 9 days in the stent group of patients and 15 days in the gastrojejunostomy group of patients (P=0.003). The mean survival periods were 11 months in the stent group of patients and 10 months in the gastrojejunostomy group of patients (P=0.937). Conclusion: There were no significant differences In the mean survival rates. An earlier first meal and a shorter hospitalization stay were found in the slanting group of patients compared to the bypass gastrojejunostomy group of patients. However, re-slanting was a concern due to tumor ingrowth and stent migration.