• Childhood Kidney Diseases
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• v.11 no.2
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• pp.212-219
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• 2007

Purpose : It is difficult to diagnose acute pyelonephritis(APN) in young children, because of their nonspecific symptoms. The younger the age, the higher the risk of renal scars after APN, which can be prevented by early diagnosis and treatment. We compare the significance of renal imaging studies by age for diagnosis of APN in febrile urinary tract infection(UTI) in children. Methods : Fifty-three hospitalized children(34 patients under age 2 and 19 patients over age 2) with febrile UTI and who had undergone dimercaptosuccinic acid(DMSA) scan, renal ultra sonography(RUS) and voiding cystourethrography(VCUG) during the acute stage were re-viewed. We compared the renal imaging studies between the different age groups. Results : The DMSA scan showed cortical defects in 23.5% of patients under age 2, which was significantly lower than 63.2% of patents over age 2(P<0.05). The renal cortical defects on DMSA scan were associated only with a high peripheral leukocyte count, but not with fever duration, erythrocyte sedimentation rate(ESR), and C-reactive protein(CRP). And there was no correlation between the DMSA scan, VCUG or RUS findings. Conclusions : The DMSA scan is not sensitive for diagnosis of APN in children less than 2 years of age and the findings cannot predict the presence of vesicoureteral reflux(VUR). VCUG may be necessary for proper management in this age group.

• Childhood Kidney Diseases
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• v.14 no.1
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• pp.71-78
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• 2010

Purpose : Hydronephrosis is found about 30% of children with urinary tract infection (UTI). It can be caused by various conditions, although most childhood hydronephrosis is congenital. This study was performed to investigate the relationship between febrile UTI and hydronephrosis. Methods : We retrospectively reviewed the medical charts of 183 patients diagnosed as UTI between January 2007 and May 2009 at Korea University Guro Hospital. Inclusion criteria were as followings; 1) fever more than $37.5^{\circ}C$ measured in the axilla, 2) positive urine culture, 3) no history of urinary tract anomaly on antenatal sonography and urinary tract infection. We classified the enrolled children into two groups of patients with hydronephrosis (HN) and those without hydronephrosis (NHN). Results : The 80 patients were HN and 103 patients NHN. Hydronephrosis was found in 58 patients with left kidney, 8 right and 14 both kidneys. Most of hydronephrosis were of low grade. Compared with NHN group, initial renal cortical defects on DMSA scan significantly increased in HN group (HN 37.5%, NHN 16.5%, P<0.05). The incidence of VUR was not different between the two groups (HN 22%, NHN 12.1%). White blood cell counts and C-reactive protein were not different between the two groups. Follow-up DMSA scan (about 6 months later after UTI) showed no difference of renal scarring in both two groups. Conclusion : Our data suggests that hydronephrosis in febrile UTI patients is clinically useful for detecting renal cortical defects, but is not associated with follow-up renal scar.

• Journal of Chest Surgery
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• v.54 no.1
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• pp.31-35
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• 2021

Background: Arteriovenous fistula (AVF) for hemodialysis is essential for patients with end-stage renal disease. However, it is difficult to maintain AVF reliably. It is vitally important to select proper blood vessels for AVF formation. In a previous study, a minimum diameter of 3 mm for the autologous vein was proposed. However, patients who did not meet the minimum vascular diameter before anesthesia, but fulfilled other criteria, showed satisfactory venous dilatation after brachial plexus block (BPB). This study investigated the extent of vein expansion by BPB and the surgical outcomes of dilated veins after BPB. Methods: Sixty-one patients who underwent AVF formation using an autologous vein between August 2018 and December 2019 were included in the study. The clinical characteristics of the patient groups, hemodynamic parameters including the diameter of blood vessels before and after BPB, and complications were investigated. Based on the venous diameter measured by sonography before anesthesia, patients were divided into group A (26 patients) and group B (35 patients), with venous diameters <3 mm and ≥3 mm, respectively. Results: The venous diameter expanded after anesthesia by 41% overall, by 62% in group A, and by 25% in group B. This difference between groups A and B was statistically significant (p=0.001). No other variables showed statistically significant differences. Conclusion: Sufficient venous dilatation was observed after BPB. Therefore, if the vein is sufficiently dilated after BPB, even in patients with a pre-anesthesia venous diameter <3 mm, surgery may still be performed with an expected desirable outcome.

• Childhood Kidney Diseases
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• v.14 no.2
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• pp.195-202
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• 2010

Purpose : The purpose of this study is to determine if there are prognostic factors leading to permanent parenchymal damages to kidney in children after acute pyelonephritis. Methods : This study was conducted in 160 pediatric patients with acute pyelonephritis admitted to Ajou University Hospital from 2000 to 2005, whose renal cortical defects were confirmed by $^{99m}Tc$-dimercaptosuccinic acid scintigraphy (DMSA scan). Along with the follow-up DMSA scan after 6 months, they were classified into two groups; recovered group (106) and scarred group (54). The clinical characteristics of each group were compared. Results : Among the total of 160 patients, 106 (66.3%) showed recovery of the initial defect (the recovered group), while 54 (33.8%) showed permanent defects on the followup DMSA scan (scarred group). Recovery rate was poor for patients of 1 year and older, or patients with the duration of fever and pyuria longer than 7 days. The recovery rate was poor in the patients with history of frequent febrile episodes and abnormal results of imaging studies, such as voiding cystourethrography (VCUG), ultrasonography. Conclusion : The recovery rate of children with renal defects on DMSA scan with acute pyelonephritis was lower when the patient is older than 1 year, when the duration of fever and pyuria exceeded 7 days, and when the patients had the histories of frequent febrile episodes and had urinary tract abnormalities on imaging studies. These findings suggest that there may be under- or mis-diagnosis of acute pyelonephritis by pediatrician.

• Journal of Korea Association of Health Promotion
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• v.2 no.3
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• pp.73-96
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• 2004

Along with a development of medical technology, a variety of tests, such as laboratory tests, x-ray and endoscopies are being used in health screening tests. As the tests determine the quality of health screening, test items and methods should be carefully selected. This study was to get hold of the test items of major health screening programs in Korea Most of the health screening programmes focused upon detection of risk factors and diagnosis of life - style related diseases (diabetes, hypertension, cardiovascular diseases, hypercholesterolemia, overweight, drinking, smoking, cerebrovascular diseases, osteoporosis) ,cancers (stomach, cervix, lung, breast, liver, colon, prostate, ovary, pancreas, thyroid, esophagus) , infectious diseases (hepatitis, tuberculosis, sexually-transmitted diseases, parasites) , chronic obstructive respiratory diseases, chronic renal diseases (bacteriuria hematuria, proteinuria) , anemia, glaucoma, hearing loss, Alzheimer disease, stress, early psychiatric diseases. The health screening tests were basic physical examination, basic laboratory tests (CBC, urinalysis, liver function tests, lipid tests, glucose, HbAlc, uric acid, electrolytes, serological tests (HBsAg, HBs-Ab, HCV-Ab, HIV-Ab, VDRL) EKG, x-ray (chest PA, CT) , endoscopy (gastroscopy, colonoscopy) , sonography(abdomen, thyroid, pelvis, breast) ,cytology (cervix) , bone density, tumor markets (NMP22, alpha-FP, CEA, CA-19-9, CA12S, PSA) and eye tests. Advanced technologies, like CT, PET, MRI, MRT/Angio, molecular testings) were widely used in hospital health screening programmes .In summary, a variety of tests were utilized in health screening in Korea. Those tests were utilized by stages or according to sex and age in most of health screening programmes, however a few program used tests to excess disregarding health screening subjects.

• Journal of Korea Association of Health Promotion
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• v.2 no.1
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• pp.9-25
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• 2004

Along with a development of medical technology, a variety of tests, such as laboratory tests, x-ray and endoscopies are being used in health screening tests. As the tests determine the quality of health screening, test items of major health screening program in Korea. Most, of the health screening programmes focused upon detection of risk factors and diagnosis of life-style related diseases(diabetes, hypertension, cardiovascular diseases, hypercholesterolemia, overweight, drinking, smoking, cerebrovascular diseases, osteoporosis), cancers(stomach, cervix, lung, breast, liver, colon, prostate, ovary, pancreas, thyroid, esophagus), infections diseases(hepatitis, tuberculosis, sexually-transmitted diseases, parasites), chronic obstructive respiratory diseases, chronic renal diseases(bacteriuria, hematuria, proteinuria), anemia, glaucoma, hearing loss, Alzheimer disease, stress and earlypsychiatric diseases. The health screening tests were basic physical examination, basic laboratory tests( CBC, urinalysis, liver function tests, lipid tests, glucose, HbA1c, uric acid, electrolytes, serological tests(HBsAg, HBs-Ab, HCV-Ab, HIV-Ab, VDRL) EKG, x-ray(chest PA, CT) endoscopy(gastroscopy, colonoscopy), sonography (abdomen, thyroid, pelvis, breast), cytology(cervix), bone density, tumor markers(NMP22, alpha-FP, CEA, CA-19-9, CA125, PSA and eye tests. Advanced technologies, like CT, PET, MRI, MRI/Angio, molecular testing were widly used in hospital based health screening programmes. In summary, a variety of tests were untilized in health screening in Korea. Those tests were utilized by stages or according to sex and age in most of health screening programmes, however a few programs used tests excessvely disregarding health screening subjects.

• Journal of Korea Association of Health Promotion
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• v.2 no.2
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• pp.215-230
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• 2004

Along with a development of medical technology, a variety of tests, such as laboratory tests, x-ray and endoscopies are being used in health screening tests. As the tests determine the quality of health screening, test items and methods should be carefully selected. This study was to get hold of the test items of major health screening programs in Korea. Most of the health screening programmes focused upon detection of risk factors and diagnosis of life-style related diseases(diabetes, hypertension, cardiovascular diseases, hypercholesterolemia, overweight, drinking, smoking, cerebrovascular diseases, osteoporosis) ,cancers(stomach, cervix, lung, breast, liver, colon, prostate, ovary, pancreas, thyroid, esophagus), infectious diseases (hepatitis, tuberculosis, sexually-transmitted diseases, parasites),chronic obstructive respiratory diseases, chronic renal diseases(bacteriuria, hematuria, proteinuria), anemia, glaucoma, hearing loss, Alzheimer disease, stress, early Psychiatric diseases. The health screening tests were basic physical examination, basic laboratory tests(CBC, urinalysis, liver function tests, lipid tests, glucose, HbAlc, uric acid, electrolytes, serological tests(HBsAg, HBs-Ab, HCV-Ab, HIV-Ab, VDRL) EKG, x-ray(chest PA, CT), endoscopy (gastroscopy, colonoscopy) , sonography(abdormen, thyroid, pelvis, breast) , cytology(cervix) ,bone density, tumor markers(NMP22, alpha-FP, CEA, CA-19-9, CA12S, PSA) and eye tests. Advanced technologies, like CT, PET, MIRI, MIRI/Angio, molecular testings) were widely usedin hospital health screening programmes. In summary, a variety of were utilized by stages or programmes, however a few subjects. tests were utilized in health screening in Korea. Those tests according to sex and age in most of health screening program used tests to excess disregarding health screening subject.

• Pediatric Infection and Vaccine
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• v.11 no.1
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• pp.90-100
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• 2004

Objective : Urinary tract infection(UTI) is a frequent serious bacterial infection in young infants. The clinical presentation may be non-specific and variable, depends on factors such as the age and the level of infection. Children with renal involvement may be at risk of permanent renal damage. Experimental studies have shown that renal lesions caused by acute febrile UTI may be prevented or diminished by early diagnosis and treatment. Therefore, it is important to find a method that can permit early diagnosis and identification of patients who are at risk for progressive renal damage. We designed this study to identify related factors in culture positive UTI infants, and also to identify related factors in culture negative UTI infants, who are febrile with pyuria, by using renal imaging and functional studies including renal sonography, DMSA scan and VCUG. Methods : Retrospectively analyzed the medical records of 136 febrile infants with pyuria over 2 years(from January 2001 to February 2003). Urine culture was done in all cases, and regardless of urine culture findings, renal imaging study was done if symptomatic UTI suspected. Results : Total 57 organisms were isolated in 53 patients. E. coli was the most common organism(86%), followed by E. faecalis, M. morganii, Proteus species, P. aeruginosa, S. aureus and E. fergusonii. Most of the isolates had high sensitivity on cephalosporins or amikacin and had low sensitivities on aminopenicillins. Abnormal acute phase DMSA scan or VCUG findings were seen in both urine culture positive and negative group without statistical differences(P>0.05). In febrile infants with pyuria, fever over 48 hours, older age and high CRP related to abnormal acute phase DMSA scan findings regardless urine culture results. Conclusion : 1st or 3rd generation cephalosporins with amikacin could be the first choice of treatment for UTI. Febrile infants with positive urine culture dose mean urinary tract infection but not acute pyelonephritis which directly relates to cortical damage which could be confirmed by acute phase DMSA scan. Even cases with negative urine culture findings, acute pyelonephritis should be concerned in febrile infants with pyuria who are older than 3 months of age, has fever over 48 hours or high CRP level. And in such cases, acute phase DMSA scan and VCUG should be evaluated for early treatment and long term prognosis.

• Clinical and Experimental Pediatrics
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• v.46 no.4
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• pp.351-357
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• 2003

Purpose : To raise awareness of the clinical importance of, and the need for proper management of acute focal bacterial nephritis(AFBN), we analyzed 22 AFBN patients and 22 other upper urinary tract infection patients by use of comparative studies. Methods : From January 2000 to May 2002, 22 AFBN patients aged from 1 month to 12 months were selected. As a control group, 22 UTI patients with no radiologic abnormalities were selected and matched by age and sex. Results : The incidence of AFBN was more common in boys than in girls. Since both groups had similar symptoms, it was difficult to diagnose AFBN by clinical presentations alone. ESR and CRP were significantly higher in AFBN patients. The most common causative organism was E. coli in both groups. On the sonographic findings, the most lesions were seen on the upper lobe of the kidney; more frequently, on left kidney. The lesions showed globular or wedge-shaped increased echogenecity. $^{99m}Tc-DMSA$ scan showed the complete coincidence of the location, size and shape in all cases compared to the findings of renal sonography. Conclusion : The roles of renal sonography and DMSA scan were very important, and ultrasonography was an excellent initial tool in diagnosing AFBN. Since the degree of infection in AFBN is more severe than other urinary tract infections and evollution into a renal abscess is possible, early diagnosis and appropriate antibiotics therapy is essential.

• Clinical and Experimental Pediatrics
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• v.54 no.5
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• pp.219-223
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• 2011

McKusick-Kaufman syndrome (MKS) is an autosomal recessive multiple malformation syndrome characterized by hydrometrocolpos (HMC) and postaxial polydactyly (PAP). We report a case of a female child with MKS who was transferred to the neonatal intensive care unit of Seoul National University Children's Hospital on her 15th day of life for further evaluation and management of an abdominal cystic mass. She underwent abdominal sonography, magnetic resonance imaging, genitography and cystoscopy which confirmed HMC with a transverse vaginal septum. X-rays of the hand and foot showed bony fusion of the left third and fourth metacarpal bones, right fourth dysplastic metacarpal bone and phalanx, right PAP and hypoplastic left foot with left fourth and fifth dysplastic metatarsal bones. In addition, she had soft palate cleft, mild hydronephroses of both kidneys, hypoplastic right kidney with ectopic location and mild rotation, uterine didelphys with transverse vaginal septum and low-type imperforated anus. She was temporarily treated with ultrasound-guided transurethral aspiration of the HMC. Our patient with HMC and PAP was diagnosed with MKS because she has two typical abnormality of MKS and she has no definite complications of retinal disease, learning disability, obesity and renal failure that develop in Bardet-Biedl syndrome, but not in MKS until 33 months of age. Here, we describe a case of a Korean patient with MKS.