소아 간질 환자에서 valproate 투여 후 혈소판 수의 변화

위주희,김영미,남상욱 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.1

Purpose : In adults, valproate (VPA) has been reported to be associated with thrombocytopenia. However, few studies have investigated this association in children, and the factors affecting platelet counts remain controversial. This study was undertaken to investigate changes in platelet counts following VPA therapy and related factors in children with epilepsy. Methods : Our subjects comprised 75 epileptic children who had received VPA monotherapy for at least 1 year between January 2000 and December 2005. We regularly examined platelet counts at intervals of 6 to 12 months after baseline platelet counts before VPA treatment. We analyzed changes in platelet counts according to several factors such as sex, seizure type, underlying causes of epilepsy, age at the start of medication as well as at the last follow up, duration of VPA administration, VPA dose, serum VPA level, and body weight at the last follow up. Results : Overall, the platelet counts decreased significantly after VPA therapy. The average baseline platelet count was 312.5±109.1×106/mL. At the last follow up, the average platelet count was 261.7±72.2×106/mL. We observed the relationship between platelet counts and serum levels of VPA; while children with serum VPA <75 µg/mL showed no change in platelet counts (P=0.102), children with serum VPA >75 µg/mL showed a significant decrease in platelet counts. Conclusion : VPA may cause a significantly decreased platelet count in children with epilepsy. High serum VPA levels were associated with development of thrombocytopenia. 목 적 : 소아 간질 환자에서 VPA 투여가 혈소판 수의 변화에 미치는 영향과 이에 관련된 인자들을 알아보고자 본 연구를 시행하였다. 방 법 : 2000년 1월부터 2005년 12월 사이에 부산대학교병원 소아과에서 간질로 진단 받고 VPA 단독 투여를 1년 이상한 환자 448명 중에서 6-12개월 간격으로 정기적인 혈액검사를 시행한 환아 75명을 대상으로 하였다. 성별, 경련의 형태, 간질의 원인이 되는 기저 질환의 유무, VPA 투여 전 연령, 최종 추적 시 연령, 투약 용량, 투약 기간, 혈중 VPA 농도, 투여 전 체중에 따른 두 군으로 분류하여 투여 전과 투여 후 가장 최근에 검사한 혈소판 수의 변화를 비교, 분석하였다. 결 과 : 전체 대상 환자 75명 중 54(72.0%)명이 투여 전에 비해 투여 후 최종 추적 시 혈소판 수가 통계적으로 유의하게 감소하였다(P=0.0001). 성별, 경련의 형태, 간질의 원인, VPA 투여 시작 연령, 최종 추적 시 연령, 투약 용량, 투약 기간, 체중을 기준으로 나눈 여러 군에서 VPA 투여 전과 투여 후 최종 추적 시 혈소판 수는 모두 통계적으로 의미 있는 감소를 보였다(P<0.05). 혈중 VPA 농도 75 µg/mL 이하인 환자군(P=0.102)에서는 치료 전과 치료 후 최종 추적 시 혈소판 수 비교에서 의미 있는 감소를 보이지 않은 반면 75 µg/mL 이상인 환자군(P=0.0000003)에서는 의미 있는 감소를 보였다. 또한 혈중 VPA 농도가 높을수록 혈소판 감소가 더 현저히 관찰되었다(r=-0.4). 결 론 : VPA 치료는 유의한 혈소판 수의 저하를 일으키나 심한 혈소판 저하증의 빈도는 낮으며, 임상 증상을 초래하는 경우는 드물다. VPA 투여 후 혈소판 감소 발생에 관계된 예측 인자로 혈중 VPA 농도가 가장 중요하므로 수술 예정이거나 혈소판 감소를 유발할 수 있는 다른 약물을 병용하는 경우, 고농도의 VPA 투여가 필요한 환자에 있어서는 주기적인 혈중 농도 검사가 권장된다.

소아 간질 환자에서 장기적인 신장 변화의 추적 관찰

위주희,남상욱 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.10

Purpose:To assess the height growth of children with epilepsy receiving antiepileptic drugs (AEDs) and the related factors. Methods:The subjects were 148 children diagnosed with epilepsy at Pusan National University Hospital between January 1996 and December 2003, who received AEDs for more than 3 y. We measured height at the initiation of AED medication and at the last visit during AED medication. We analyzed the mean height standard deviation score (SDS) according to several factors, including sex, age at initial medication, seizure type, underlying causes of epilepsy, seizure frequency before AED medication, seizure control, number of AEDs, height SDS before medication, and duration of medication. Results:In the total population, height SDS at initial therapy and last follow-up were -0.06±1.39 versus 0.10±1.12 (P= 0.09). Children with controlled seizures showed a significant increase in height SDS, from -0.12±1.39 to 0.10±1.09 (P= 0.04), and children on medication for less than 6 y showed a significant increase in height SDS, from -0.09±1.54 to 0.21±1.07 (P=0.03). Also, children with negative initial height SDS showed a significant increase in height SDS (P<0.05). No height SDS changes were observed in any of the other groups, regardless of sex, seizure type, underlying causes of epilepsy, or age at initial medication. Conclusion:Neither epilepsy nor AED medication affects long-term height growth. Controlled seizure and short duration of AED medication are positive factors for height growth in children with epilepsy. (Korean J Pediatr 2008;51:1090-1095) Purpose:To assess the height growth of children with epilepsy receiving antiepileptic drugs (AEDs) and the related factors. Methods:The subjects were 148 children diagnosed with epilepsy at Pusan National University Hospital between January 1996 and December 2003, who received AEDs for more than 3 y. We measured height at the initiation of AED medication and at the last visit during AED medication. We analyzed the mean height standard deviation score (SDS) according to several factors, including sex, age at initial medication, seizure type, underlying causes of epilepsy, seizure frequency before AED medication, seizure control, number of AEDs, height SDS before medication, and duration of medication. Results:In the total population, height SDS at initial therapy and last follow-up were -0.06±1.39 versus 0.10±1.12 (P= 0.09). Children with controlled seizures showed a significant increase in height SDS, from -0.12±1.39 to 0.10±1.09 (P= 0.04), and children on medication for less than 6 y showed a significant increase in height SDS, from -0.09±1.54 to 0.21±1.07 (P=0.03). Also, children with negative initial height SDS showed a significant increase in height SDS (P<0.05). No height SDS changes were observed in any of the other groups, regardless of sex, seizure type, underlying causes of epilepsy, or age at initial medication. Conclusion:Neither epilepsy nor AED medication affects long-term height growth. Controlled seizure and short duration of AED medication are positive factors for height growth in children with epilepsy. (Korean J Pediatr 2008;51:1090-1095)

딥러닝의 다수 입력 이미지 학습 및 추론 효율 향상을 위해 추가적인 처리 프로세스 연구

최동규(Donggyu Choi),김민영(Minyoung Kim),장종욱(Jongwook Jang) 한국정보통신학회 2021 한국정보통신학회 종합학술대회 논문집 Vol.25 No.2

실생활에는 많은 카메라가 활용되고 있으며 단순한 추억을 위한 사진 촬영을 넘어서 문제 상황을 확인하기 위하여 감시, 방범을 위하여 많이 사용되고 있다. 이러한 감시와 방범은 일반적인 형태로 단순한 저장으로만 사용되고 있으며, 다수의 카메라를 활용하는 시스템에서는 추가 기능을 활용하는 것은 하드웨어의 추가적인 사양을 요구하게 된다. 본 논문에서는 일반적인 이미지 처리에서 벗어난 객체 감지 시스템을 수행하는 하나의 하드웨어 또는 서버에서 입력된 여러 개의 이미지 입력 처리하기 위해 이미지 입력 방법과 객체 감지 이후 처리 프로세스를 추가한다. 방법의 수행은 딥러닝을 수행하는 하드웨어의 학습과 추론에 모두 활용해 보며 개선된 이미지 처리 프로세스를 수행할 수 있도록 한다. Many cameras are used in real life, and they are often used for monitoring and crime prevention to check the situation of problems beyond just taking pictures for memories. Such surveillance and prevention are generally used only for simple storage, and in systems utilizing multiple cameras, utilizing additional features would require additional hardware specifications. In this paper, we add image input methods and post-object processing processes to process multiple image inputs from one hardware or server that perform object detection systems that deviate from typical image processing. The performance of the method is utilized in both learning and reasoning of the hardware performing deep learning, and allows improved image processing processes to be performed.

소아 간질 환아에서 valproate 투여 후 혈소판 수 변화

위주희,남상욱 부산대학교 병원 암연구소 2007 부산대병원학술지 Vol.- No.21

Purpose: It has been known that valproate (VPA) therapy is associated with thrombocytopenia. But few studies have been conducted in children and there are conflicting results about the factors which affect the changes of platelet counts. This study was undertaken to investigate the changes of platelet counts after VPA therapy and the risk factors of platelet count changes in children taking VPA with epilepsy. Subject and Methods: Subjects were 75 children with epilepsy who had received VPA monotherapy over a period of2 months from January 2000 to December 2005. We checked platelet counts before VPA therapy and after VPA therapy for 2months and analyzed the relationship between changes in platelet counts and other factors such as sex, seizure type, underlying causes of epilepsy, age, VPA dose, serum VPA levels, and body weight. Results: In total population, the platelet counts were not changed significantly at 2 months after VPA therapy. The initial platelet count was 312.5± 109.1 X 10^(6)/mL. At 2months after VPA therapy, platelet count was 294.6±94.7x 10^(6)/ mL(P=0.054). The relationship between the platelet count decrease and other factors such as age and blood levels of VPA was observed in our study. In children older than 6 years old, the platelet counts before and two months after VPA theray were 295.1±85.4 X 10^(6)/mL, 275.6±94.3x 10^(6)/mL(P=0.027). In children who had serum VPA level higher than 75 μg/mL, the platelet counts before and two months after VPA theray were 324.1 X 102.4 X 10^(6)/mL, 297.4 ± 105.7 X 106/mL(p=0.028). The platelet count change was not affected by the other factors such as sex, seizure type, underlying causes of epilepsy, VPA dose, and body weight. Conclusions: The platelet counts don’t show any change 2 months after VPA therapy. But Older age and high blood level of VPA are risk factors of the decrease of platelet counts. Regular monitoring of serum VPA level and platelet counts is recommended especially in these group.

소아에서 발생한 S상 결장 염전증 1예

이동한,위주희,박현석,김해영,박재홍,Lee, Dong-Han,We, Ju-Hee,Park, Hyun-Seok,Kim, Hae-Young,Park, Jae-Hong 대한소아소화기영양학회 2010 Pediatric gastroenterology, hepatology & nutrition Vol.13 No.2

본 증례는 1년 전부터 갑작스럽게 복부팽만과 복통이 반복하다 내원 10일 전부터 심한 복통과 복부팽만, 구토가 발생하여 내원한 9세 남자 환자이다. 복부 X-선 촬영과 바륨 관장 등의 검사로 S상 결장 염전증을 진단하고 내시경적 염전 정복과 감압술 시도하였으나 실패하였다. 수술 시야에서 심하게 확장되고 비정상적으로 긴 S상 결장과 굵은 혈관이 포함된 결장간막이 관찰되었고 S상 결장의 원위부 및 근위부에서 좁아진 부위를 확인하여 이 부분을 포함한 S상 결장 절제술을 시행하였다. 이후 환자는 5년 동안의 추적관찰에서 증상의 재발이 없었다. Sigmoid volvulus may cause acute or subacute colonic obstruction. Excessive length of the sigmoid colon may be a contributing factor. Typically, the patient develops bilious vomiting and marked gaseous abdominal distension. We report a case of sigmoid volvulus in a 9-year-old boy who presented with recurrent, sudden onset abdominal pain, abdominal distension, and vomiting for 1 year, which was diagnosed by simple abdominal X-ray, barium enema, computed tomography, and colonoscopic examination. Colonoscopic reduction failed and a sigmoid colectomy with primary repair was performed. The intra-operative findings showed that the sigmoid colon was noted to be dilated, and redundant with a lax mesentery. Two clear areas of compression (proximal and distal) were present. After sigmoidectomy, the symptoms resolved. After 5 years of follow-up, he had no new symptoms.

소아 복통에서 소아과 의사에 의한 초음파 검사의 유용성

박현석,위주희,박재홍,Park, Hyun-Seok,We, Ju-Hee,Park, Jae-Hong 대한소아소화기영양학회 2011 Pediatric gastroenterology, hepatology & nutrition Vol.14 No.2

목적: 초음파 검사는 복통 환자의 선별 검사로 널리 사용되고 있다. 소아의 복통 환자에서 소아청소년과 의사에 의해 시행된 초음파 검사의 유용성에 대해 조사하였다. 방 법: 2008년 11월부터 2010년 6월까지 복통을 주소로 복부 초음파 검사를 받았던 소아 환자의 의무기록을 후향적으로 분석하였다. 결 과: 대상 환자는 628명(남자 325명, 여자 303명)이었고, 평균 연령은 $8.08{\pm}4.61$세였다. 급성 복통이 427명(68.0%), 1개월 이상의 만성 복통이 201명(32.0%)이었다. 복통의 위치는 미만성 36.9%, 배꼽주위 24.4%, 상복부 21.0%, 우하복부 8.1%, 하복부 3.0%, 우상복부 2.9%, 좌하복부 2.4%, 좌상복부이 1.3%였다. 327명(52.1%)에서 특이 소견이 없었고, 이상 소견이 있었던 301명(47.9%) 중 장간막 림프절염 170명, 소장염 또는 대장염 55명, 장중첩증 19명, 급성 충수돌기염 16명, 담관낭종 10명, Henoch-Sh$\ddot{o}$lein purpura 8명, 췌장염 2명이었다. 39명(6.2%)에서 복부 컴퓨터 단층 촬영 또는 자기공명촬영 검사가 병행되었는데 33명에서 동일한 결과가 나왔다. 복부 컴퓨터 단층 촬영을 통해 충수돌기염 2명, 췌장염 1명, Henoch-Sch$\ddot{o}$nlein purpura 1명이 진단되었다. 그러나 복부 초음파 검사에서 충수돌기염이 의심되었던 2명은 복부 컴퓨터 단층 촬영에서 진단이 되지 않았으나 수술을 통해 최종 충수돌기염으로 확진되었다. 전체 환자 중 624예(99.4%)에서 초음파 검사 결과와 최종 진단이 일치하였다. 결론: 소아과 의사에 의한 초음파 검사는 소아 복통의 감별진단에 신속하고 정확한 정보를 줌으로써 선별 검사로써 가치가 높으며 비침습적이고 방사선 조사가 없는 장점이 있다. Purpose: Ultrasonography (US) is widely used as a screening test in patients with abdominal pain (AP). We investigated the usefulness of US by a pediatrician in children with AP. Methods: We retrospectively analysed the medical records of children with AP who undertook US from December, 2008 to July, 2010. Results: A total of 628 patients (325 male, 303 female) were enrolled in this study. The mean age of patients was $8.08{\pm}4.61$ years. Duration of AP was acute in 427 and chronic in 201 patients. Localization of AP was diffuse (36.9%), periumbilical (24.4%), epigastric (21.0%), and right lower quadrant (8.1%). On the examination, there were no abnormal findings in 327 patients (52.1%). Abnormal ultrasonographic findings were mesenteric lymphadenitis (27.1%), intestinal mural thickening (10.0%), intussusception (3.0%), appendicitis (2.6%), choledochal cyst (1.6%), and pancreatitis (0.3%). We performed additional imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) in 39 patients who showed obscure findings on the US. In 33 patients (84.6%), the same results were obtained from CT or MRI. Two cases of appendicitis, one case of pancreatitis and one case of Henoch-Sh$\ddot{o}$nlein purpura were diagnosed by the CT examination. However, there were two cases of appendicitis diagnosed by US thathad no evidence of appendicitis on the CT. Diagnostic accuracy of initial US in children with abdominal pain was 99.4%. Conclusion: US by a pediatrician as a screening test in children with AP provides a rapid and accurate diagnostic indication and has non-invasive and radiation-free advantages.

소아 기능성 변비의 치료에 영향을 미치는 인자

김형석,홍유라,위주희,박재홍,Kim, Hyung-Seok,Hong, You-Rha,We, Ju-Hee,Park, Jae-Hong 대한소아소화기영양학회 2010 Pediatric gastroenterology, hepatology & nutrition Vol.13 No.1

목 적: 소아에서 기능성 변비는 흔히 볼 수 있는 질환이지만 임상적 경과 및 치료 반응에 대한 대단위 연구가 없는 실정이다. 이 질환의 임상적 특징과 치료에 영향을 미치는 인자들을 알아보고자 본 연구를 시행하였다. 방 법: 1998년 1월부터 2007년 12월까지 부산대학교 병원 소아과에서 변비로 치료를 받았던 500명 중 Iowa 기준에 따라 기능성 변비로 1개월 이상 치료를 받고 경과관찰이 가능하였던 240명의 환자를 대상으로 후향적조사를 하였다. 변비의 주 치료제로 락툴로스를 복용한 군(145명)과 PEG (polyethylene glycol)를 복용한 군(95명)으로 나누었다. 환자에 따라 magnesium hydroxide, psyllium, bisacodyl, domperidone, 고장성 인산염 관장액등을 병용하였다. 치료 반응은 약물 투여 후 이틀에 1회 이상 통증이 없이 배변을 하는 시점으로 하였고, 치료 반응이 3개월 이상 유지되면 약물을 감량하였다. 결 과: 1) 남자 142명(59.2%), 여자 98명(40.8%)이었고, 발병 시 연령은 18.7${\pm}$21.5개월, 진단 시 연령은 51.2${\pm}$37.9개월이었다. 발병 시 연령은 1세 이하가 94명(39.2%)으로 가장 많았다. 2) 증상 지속 기간은 32.6${\pm}$33.7개월, 치료 전 배변 빈도는 1회/4.8일이었다. 3) 동반 증상은 유분증 91명(30.4%), 복통 76명(31.6%), 혈변37명(15.4%), 식욕저하 23명(9.6%), 복부팽만 18명(7.5%), 구토 14명(5.8%)이었다. 4) 배변 빈도가 락툴로스 투여군 1회/4.6일로 PEG 투여군 1회/5.2일에 비해 짧았던 것을 제외하고 두 군 간에 차이는 없었다. 5) 치료 반응은 여자에서(p<0.001), 동반증상이 있었을 때(p<0.05), PEG 투여군에서(p=0.001) 의미 있게 빨랐으며, 치료 전 증상 지속 기간이 길수록(p<0.05), 배변 빈도가 적을수록(p<0.05) 늦었다. 6) 총 치료 기간은 성별, 증상 발생 나이, 증상 지속 기간, 배변 빈도, 동반 증상, 유분증 유무, 타병원에서의 치료, 민간 요법 시행, 치료 약물의 종류와 무관하였다. 7) 7명(락툴로스군 6명, PEG군 1명)에서 치료 후 재발이 있었으나, 2명을 제외하고 재치료로 완치되었다. 결 론: 여자, 치료 전 증상 지속 기간 및 배변 빈도가 치료 반응에 중요한 인자였고, PEG가 락툴로스에 비해 치료 반응 시간이 짧았기 때문에 1차 치료 약제로 고려해 볼 수 있겠다. 총 치료 기간에 영향을 미치는 요인은 없었으나, 조기 치료가 치료 반응 및 치료 기간을 단축할 수 있으리라 판단된다. Purpose: The aim of this study was to evaluate the clinical features and factors contributing to treatment outcome for chronic functional constipation in children. Methods: We analyzed the medical records of patients with constipation, who visited the inpatient or outpatient clinic of the Department of Pediatrics of Pusan National University Hospital, between January 1998 and December 2007. The clinical features, outcomes, and factors affecting the treatment response according to the main drug (lactulose vs. PEG 4000) were analyzed retrospectively. Results: Two hundred forty children (142 males and 98 females) were enrolled in this study. The mean age was 51.2${\pm}$37.9 months. The duration of symptoms was 32.6${\pm}$33.7 months. The accompanying symptoms were as follows: encopresis, 91 (30.4%); abdominal pain, 76 (31.6%); and blood-tinged stool, 37 (15.4%). The treatment response was achieved earlier in females (p<0.001), patients with accompanying symptoms (p<0.05), and patients treated with PEG 4000 (p=0.001). The duration of symptoms (p<0.05) and stool frequency before treatment (p<0.05) were related to a delayed treatment response. Relapse occurred in 7 children, all of whom were treated successfully later. Conclusion: Factors contributing to treatment response are female gender, accompanying symptoms, duration of symptoms, and stool frequency before treatment. PEG 4000 is superior to lactulose in response time and taken into consideration as a primary drug for the treatment of functional constipation of children. Early treatment and sufficient treatment time may also be important factors to achieve an early response and prevent relapse.

Needle aspiration as therapeutic management for suppurative cervical lymphadenitis in children

백미영,박경희,위주희,박수은 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.8

Purpose: This study aimed to evaluate the usefulness of the needle aspiration alternative to open surgical drainage of children with suppurative cervical lymphadenitis requiring surgical drainage. Methods: From January 1998 to June 2008, we retrospectively reviewed 38 children treated with needle aspiration as management with suppurative cervical lymphadenitis instead of open surgical drainage. Results: All 38 children underwent only 1 puncture. Two patients (5.2%) out of 38 patients experienced reformation of an abscess and all recovered completely after re-treatment with antibiotics. Minor complications were detected in 2 patients (5.2%). One complication originated from remnant necrotic tissue and the other involved formation of a small scar in two patients, which resolved spontaneously. There were no major complications. Conclusion: Needle aspiration can be a simple, safe, and effective alternative procedure to open surgical drainage of children with suppurative cervical lymphadenitis requiring surgical drainage.

Accuracy of an Interferon-gamma Release Assay to Detect Active Tuberculosis in Children: A Pilot Study

이영진,박수은,천베드로,위주희 대한소아감염학회 2011 Pediatric Infection and Vaccine Vol.18 No.1

Purpose:Early diagnosis of active tuberculosis (TB) in children is difficult. The widely used tuberculin skin test has low sensitivity and cross reactivity with non-tuberculous mycobacteria or Bacille Calmette-Guérin vaccination. Interferon gamma release assays have been shown good diagnostic accuracy for active in adults. But studies in children were limited. The purpose of this study was to examine the performance of enzyme-linked immunospot assay (ELISpot) as an initial test in the diagnosis of active tuberculosis in children. Methods:In a hospital-based study, we prospectively examined the performance of ELISPot in 33 children suspected of active TB. TB was confirmed bacteriologically or histologically. Results:Among 33 patients, 9 had active tuberculosis. When tested, they all had a positive test result from the ELISpot. The sensitivity and specificity of the assay were 100% (95% CI, 66.4-100%) and 95.8% (95% CI, 78.9-99.9%) respectively. Conclusion:ELISpot might be an useful and improved clinical diagnostic method for the detection of active TB in children.