소아 신증후군에서의 혈전증

구자욱,박혜원,최용,정해일,하일수,하태선 대한신장학회 1993 Kidney Research and Clinical Practice Vol.12 No.4

We reviewed 10 nephrotic children with thromboembolic complications who were admitted to the Department of Pediatrics, Seoul National University Childrens' Hospital between May 1984 and march 1993 and the following results were obtained. 1) The patterns of thrombosis were pulmonary throm- boebolism (4 cases including 1 pulmonary artery thrombosis), cerebral infarction (2 cases), renal vein throm- bosis (2 cases), femoral artery thrombosis (1 case), radial artery thrombosis (1 case), and femoral vein with deep vein thrombosis (1 case). Among these cases, the radial artery throbmosis was accompanied with pulmonary thromboembolism. 2) The possible factors associated with thrombosis were as follows: iatrogenic factors (accidental femoral puncture and radial artery cannulation), steroid, diuretic therapy, hypovolvemic episode, sepsis and stasis. 3) Patients with only pulmonary thromboembolism or renal vein thrombosis improved considerably under the conservative treatment with systemic heparinization and anticoagulants. One patient with femoral artery thrombosis recovered completely with emergency thrombectomy, systemic heparinization and anticoagulant. Two patients were expired with massive pulmonary artery thrombosis and radial artery thrombosis. Unexplained pulmonary symptoms, decreased breathing sound and pneumonic infiltration on the chest X-ray during relapsing nephrotic syndrome should prompt further investigations to rule out Femoral artery punctures, or arterial cannulation of the extremities in patients with the nephrotic syndrome should be avoided.

소아에서 진단 복강경술과 복강경하 수술 시 심폐기능 변화

정진헌 ( Jin Hun Chung ),안기량 ( Ki Ryang Ahn ),신온섭 ( On Sub Shin ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyeon Yoo ),정지원 ( Ji Won Chung ),구자욱 ( Ja Ug Koo ),이정석 ( Jeong Seok Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1

Background: Information concerning the cardiopulmonary effects of pneumoperitoneum in children is lacking. Methods: Twenty eight patients were assigned to receive diagnostic laparoscopy (n=12) or laparoscopic surgery (n=16). Before insufflation of CO2, tidal volume was set at 10 ml/kg and respiratory rate was adjusted to achieve an end-tidal CO2 (P(ET)CO2) of 30-35 mmHg. Abdominal pressure was maintained at 10-15 mmHg by a CO2 insufflator. We measured the changes of systolic arterial pressure (SAP), heart rate (HR), P(ET)CO2 and peak airway pressure (PAP) at 5 min before (control value) and after CO2 insufflation and 5 min after CO2 deflation. Results: SAP and PAP were increased significantly after pnemoperitoneum compared with the control both in diagnostic laparoscopy and laparoscopic surgery (P<0.05). P(ET)CO2 was increased significantly after pneumoperitoneum and after CO2 deflation in laparoscopic surgery compared with the control and also with diagnostic laparoscopy (P<0.05). Driving pressure (the difference between peak airway pressure and abdominal pressure) was increased significantly after pneumoperitoneum in laparoscopic surgery compared with diagnostic laparoscopy (P<0.05). Conclusions: SAP, PAP and P(ET)CO2 increases during diagnostic laparoscopy and laparoscopic surgery, but this effect appears to be of smaller magnitude in diagnostic laparoscopy compared to laparoscopic surgery. We found that these changes had no clinically deleterious effects in healthy children. (Korean J Anesthesiol 2009;56:31~5)

Yersinia pseudotuberculosis에 의한 급성 신부전증

구자욱,박혜원,정철영,조종래,최용,정해일 대한신장학회 1996 Kidney Research and Clinical Practice Vol.15 No.3

YP can cause a wide range of clinical problems such as mesenteric lymphadenitis, erythema nodo- sum, reactive arthritis, and sepsis. We have experienced 70 cases of YP infection in children diagnosed by stool culture (46 cases) and/or serology (24 cases) since 1987, A history of drinking or contact with untreated well or mountain water was detected in 67 cases. YP was also isolated from 5 samples of mountain spring water which was thought to be the sources of infection. The most prevalent serotypes were 5b(37/70) and 4b(24/70). During the course of illness, ARF developed in 18 cases(25.796). Additionally, serogroups for those from the water samples were 5 in 4 cases. The disease began with sudden onset of fever, rash, abdominal pain sometimes mimicking acute appendicitis. Periungual desquamaton, which was prominent in the ARF group, developed later in the course. Thrombocytosis and hypoalbuminemia were noticieable, and mild degrees of proteinuria, microscopic hematuria, and sterile pyuria were common in the ARF group. ARF developed between the 2nd and 17th days(mean 8.9 days) after the onset of fever, and oliguria ($lt;400ml/ m²/day) developed in 12 patients(12/18) immediately after their fevers had subsided. ARF underwent a benign course of complete recovery within 4 weeks at most(mean 10.2 days), with two exceptional cases requiring hemodialysis. Kgh FeNa, glucouria, decreased tubular reabsorption of phosphate($lt;85%) and increased urinary 52 microglobulin excretion, were suggesting proximal tubular damage. Renal biopsy showed evidence of tubulointerstitial nephritis. YP should be included as one of the causes of acute interstitial nephritis causing ARF in children, especially when the children have histories of drinking untreated water in endemic areas.

소아 CAPD에서의 복막염

구자욱,고광욱,최용,정해일,임인석,하일수,하태선 대한신장학회 1991 Kidney Research and Clinical Practice Vol.10 No.3

A retrospective analysis of peritonitis experiments in 24 ESRD patients with a mean age of 8.6 years, who underwent CAPD at the Pediatric Department of Seoul national University Hospital from Feb. 1987 to Aug. 1990, were performed. And the results were as follows: 1) A total of 54 episodes of peritonitis occurred during 7,696 patient-days of CAPD in 20 of the 24 patients with the incidence of peritonitis at 2.6 patient-year (1 per 4.8 patient-month). The incidence of peritonitis has declined progressively during past 4 years except 1989: 4.0 episodes per patient-year in 1987, 2.6 in 1988, 3.0 in 1989, and 1.4 in 1990. 2) The first episode of peritonitis was occurred within one week of beginning CAPD in 15% within 4 weeks in 45%, within 6 months in 809. And within 1 years in 100% of those who experienced peritonitis. 3) The rate of positive and negative culture were 59. 8%. (32/54) and 37.0% (20/54), respectively. Gram positive organisms were cultured in 56.3% (18/32), gram negative organisms in 21.8%. (7/32), CNS (28.1%, 9/32) and S.aureus (21.9%., 7/32) were most prevalent organisms. 4) Peritonitis were responsible for 20.9 days of hospitalization per patient-year. Peritonitis was successfully treated in outpatient basis only 33.3% and by antibiotics only in 85.2%. The remaining 8 (14%.) patients needed to remove the catheters for the treatment. 5) A total of 14 episodes (44% of all catheters) of pericathet er infection (including exit-site and tunnel infection) occurred during same period. In 57.2% (8/14) of these infections peritonitis followed. 6) Peritoneal catheters had to be removed in 17 episodes excluding of 5 episodes due to death and renal transplantation: in 8 episodes because of peritonitis. 7) A total of 32 peritoneal catheters were implanted. Mean surviaval of all catheters was 9.2 months. The actuarial catheter survival by Kaplan-Meier method was 58.6 % and 35.4% at 6 and 12 months, respectively. In conclusion, the future of CAPD as a long term therapeutic modality depends on peritonits. Therefore, new approaches to the prevention and the treatment CAPD peritonitis should be evaluated. If infection can be successfully managed and prevented, CAPD promised to become increasingly popular for treatment of end stage renal disease.

선천성 기관식도루 환자에서 식도를 통한 기관내삽관 -증례보고-

정진헌 ( Jin Hun Chung ),송상우 ( Sang Woo Song ),안기량 ( Ki Ryang Ahn ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyeon Yoo ),정지원 ( Ji Won Chung ),구자욱 ( Ja Ug Koo ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6

H type of congenital tracheoesophageal fistula (TEF) is rare, occurring approximately once in 100,000 births. The presentation of this anomaly in adults is indeed uncommon. We report a case of a 47-year-old male with congenital TEF dectected during epidural hematoma removal under general anesthesia. Intermittent disappearance of normal capnography, bubbling sound at substernal area, and air leakage at oral cavity observed during manually assisted ventilation, especially during inspiration. We observed a H-type of TEF and tracheal intubation via esophagus in chest CT after operation. (Korean J Anesthesiol 2009; 56: 698~702)

A case of a child with non-parasitic chyluria

정다은,구자욱,김상우,정해일 대한소아청소년과학회 2006 Clinical and Experimental Pediatrics (CEP) Vol.49 No.3

Chyluria is the passage of milky urine due to the leakage of lymph into the urinary tract. Chyluria occurs predominantly in adults and is rare in children. We present an unusual case in which a child with proteinuria, hematuria and milky urine was subsequently diagnosed with non-parasitic chyluria. Retrograde cystogram confirmed a lymphatico-calyceal communication. This case showed spontaneous remission. The etiology of this case was not exactly known; however, the prognosis of non-parasitic chyluria (or idiopathic chyluria) is usually very good and the treatment is mostly conservative. 유미뇨는 비뇨기계의 림프계와 정맥계가 누관으로 연결되어 유미(chyle)가 소변으로 배설되는 것을 말한다. 평상시 건강히 지내던 10살된 남아가 딸기 우유빛 소변을 주소로 내원하여 시행한 방광경검사로 우측 요관 입구에서 우유색뇨와 혈액이 분출되는 소견을 보았고, 역행성 신우조영술로 우측신 상부에서 신우-임파역류 소견을 확인하였다. 저자 등은 비기생충증 원인의 유미뇨를 가진 환아에서 보존적 치료법만으로도 자연 치유된 유미뇨 1례를 경험하였기에 이를 보고하고자 한다.

OSS 게이트웨이의 보안 요구사항

안치홍,석승학,성열옥,한근희,정자욱 공주대학교 생산기술연구소 2002 論文集 Vol.10 No.-

OSS systems that are represented by the carrier preselection and number portability services con no longer be operated by themselves in their own domains since the freedom and various changes in electronic commerce require the interconnections between the heterogeneous OSS systems. However, since the cost of direct internonnections of OSS systems is so enormous we must consider the use of OSS gateways to interconnect heterogeneous OSS systems. In this research, we analyze the security weakness for interconnecting OSS systems throught gateways and suggest the security requirements for the OSS gateway.

Intravenous fluid prescription practices among pediatric residents in Korea

이지원,정영화,이세은,이준호,김기혁,구자욱,박영서,정해일,하일수,최용,강희경 대한소아청소년과학회 2013 Clinical and Experimental Pediatrics (CEP) Vol.56 No.7

Purpose: Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children, and have contended that hypotonic fluids be removed from routine practice. To assess current intravenous fluid prescription practices among Korean pediatric residents and to call for updated clinical practice education Methods: A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consisting of four questions. Each question supposed a unique scenario in which the respondents were to prescribe either a hypotonic or an isotonic fluid for the patient. Results: Ninety-one responses were collected and analyzed. In three of the four scenarios, a significant majority prescribed the hypotonic fluids (98.9%, 85.7%, and 69.2%, respectively). Notably, 69.2% of the respondents selected the hypotonic fluids for postoperative management. Almost all (96.7%) selected the isotonic fluids for hydration therapy. Conclusion: In the given scenarios, the majority of Korean pediatric residents would prescribe a hypotonic fluid, except for initial hydration. The current state of pediatric fluid management, notably, heightens the risk of hospital-acquired hyponatremia. Updated clinical practice education on intravenous fluid prescription, therefore, is urgently required.