다발성 췌장골절과 좌측 신경색이 동반된 피학대증후군 : 증례 보고 A Case Report

임한혁,임수재 최신의학사 1995 最新醫學 Vol.38 No.8

상하지의 방사선학적 검사를 이용한 개인 식별에 관한 연구

임한혁 대한영상의학회 1993 대한영상의학회지 Vol.29 No.4

Individual idenification procedure is one of the maost improtant part in medicolegal fields. Recently, radiolegal investigation methods have been widely applicated to the medicolegal field for the purpose of individual identification. So authors attempted to determine sex and calculate stature by using roentgenographic findings of long bones of 248 subjects in the living materials. In orthoscanographic study for long bones, we measured total length, midsheft width, epiphyseal width, cortical width, head diameter of each bones. The total length, midshaft width, cortical width, condylar breath, horizontal '||'&'||' vertical head diameter of femur show statistically significant differentiation between two sexes, in tibia, total length midshaft, cortical width, proximal and distal epiphyseal width show statistically significant. In fibula, Humerus, radius and ulna, total length is only statistically significant. And other results are statistically insignificant. Using femoral and fibial lengths (MM)with "Regression Analysis method" in SAS program, we derived the following fomulae.e.

Intervention with Balloon Valvuloplasty followed by Patent Ductus Arteriosus Stent in a Patient with Pulmonary Atresia with Intact Ventricular Septum

임한혁,김영득,장미영,이재환,길홍량,Lim, Han Hyuk,Kim, Young Deuk,Lee, Jae Hwan,Chang, Mea Young,Kil, Hong Ryang The Korean Pediatric Society 2005 Clinical and Experimental Pediatrics (CEP) Vol.48 No.11

Pulmonary atresia with intact ventricular septum (PAIVS) is rare, less than 1% of congenital heart disease. It needs a therapeutic approach according to its individual morphologic feature. Surgical treatment of valvotomy and modified Blalock-Taussig shunt or non-surgical interventional catheter balloon valvuloplasty can be used for mild to moderate hypoplasia of right ventricle. Fontan operation can be considered for less optimum morphological substrate of two ventricular repair. A 3-day-old male neonate was admitted with cyanosis and cardiac murmur. On echocardiogram, he had membranous pulmonary atresia with intact ventricular septum, normal sized tripartite right ventricle, large atrial septal defect with right-to-left shunt, small sized patent ductus arteriosus, and moderate tricuspid regurgitation. He was treated with intravenous continuous infusion of prostaglandin $E_1$ ($PGE_1$) at once. On the third day of hospitalization, Balloon valvuloplasty was performed. After insertion of patent ductus arteriosus stent on the tenth day, $PGE_1$ infusion was discontinued. On the fifteenth day, he was discharged. Now, he is 9 months old and has nearly normal cardiac structure and function with 97% of percutaneous oxygen saturation. 심실중격결손을 동반하지 않은 폐동맥 폐쇄(pulmonary atresia with intact ventricular septum)는 전체 선천적 심장병의 1%를 차지하는 드문 질환으로 형태학적 특성에 따라 다양한 치료적 접근이 필요하다. 이에 저자들은 정상 크기발달의 우심실을 가진 심실중격결손을 동반하지 않은 폐동맥 폐쇄가 있는 신생아에서 풍선판막성형술 후 지속적인 저산소증을 보여 동맥관 스텐트를 이용하여 거의 정상적인 심장구조와 기능으로 호전된 1례를 경험하였기에 보고하는 바이다.

Prevalence and risk factors of the metabolic syndrome in young adults with childhood-onset hypopituitary growth hormone deficiency

임한혁,강민재,윤인석,양세원,신충호,이영아 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.10

Purpose: This study evaluated the prevalence of the metabolic syndrome (MetS) and risk factors for metabolic derangement in young adults with childhood-onset hypopituitary growth hormone deficiency (ACOHGHD). Methods: Thirty patients with ACOHGHD who were treated with hormone-replacement therapy, aged 18 to 29 years, who visited the Seoul National University Children’s Hospital between September 2009 and February 2010 were enrolled. Height, weight, waist circumference, hip circumference, and blood pressure were measured,and the clinical and hormonal features were reviewed retrospectively. We evaluated measures of metabolic derangement in the enrolled patients and in the data of healthy adults aged 20 to 29 years taken from the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) as part of the National Cholesterol Education Program-the Adult Treatment Panel III. Results: Compared with the KNHANES participants, patients with ACOHGHD had significantly large waist circumference (men and women), high systolic blood pressure (BP) (women) and diastolic BP (men), and high serum triglyceride levels (women). The duration of illness correlated significantly with central obesity (r2=0.546, P=0.003). The prevalence of MetS was 10% in patients with ACOHGHD and 2.3% in KNHANES participants. The prevalence of central obesity and MetS was higher in patients with ACOHGHD than in KNHANES participants (P<0.001 and P=0.042, respectively). Conclusion: Abdominal obesity correlated with the duration of illness in patients with ACOHGHD. Waist circumference should be measured in the clinic to prevent MetS, particularly in patients with a long history of ACOHGHD, regardless of age or sex.

Risk factor for pituitary dysfunction in children and adolescents with Rathke’s cleft cysts

임한혁,양세원 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.7

Purpose: This study evaluated the clinical manifestations of and risk factors for pituitary insufficiency in children and adolescents with Rathke’s cleft cysts. Methods: Forty-four patients with Rathke’s cleft cysts younger than 19 years who visited Seoul National University Children’s Hospital between January 1995 and September 2009 were enrolled. Rathke’s cleft cysts were confirmed histologically through an operation in 15 patients and by brain magnetic resonance imaging (MRI) in 29patients. The clinical, hormonal, and imaging features were reviewed retrospectively. Results: The clinical presentation of symptomatic patients was as follows: headache (65%), endocrinopathy (61%), and visual disturbance (19%). Endocrinopathy included central precocious puberty (18%),diabetes insipidus (14%), general weakness (11%), and decreased growth velocity (7%). After surgery, hyperprolactinemia resolved in all patients, but growth hormone insufficiency, hypothyroidism, and diabetes insipidus did not improve. Pituitary insufficiency except gonadotropin abnormality correlated significantly with severe headache, visual disturbance, general weakness, and cystic size. Suprasellar extension of cysts and high signals in the T2-weighted image on brain MRI were related to hypothyroidism, hypocortisolism,and diabetes insipidus. Multivariable linear regression analysis showed that only general weakness was a risk factor for pituitary insufficiency (R2=0.549). Conclusion: General weakness is a risk factor for pituitary insufficiency in patients with Rathke’s cleft cysts. When a patient with a Rathke’s cleft cyst complains of general weakness, the clinician should evaluate pituitary function and consider surgical treatment.

경피적 세침 생검술 후 발생하는 폐기흉을 예방하기 위한 실험 연구 : 히스토아크릴^(®) 유용성 관찰 Using the Histoacryl^(®) Injection.

임한혁 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.2

Purpose; Percutaneous transthoracic needle aspiration(PTNA) has been used as a excellent diagnostic mathod due to it's safety and accuracy in many thoracic lesion. But the major complication of PTNA is still pneumothorax in spite of advance of skill and use fine needle. To prevent the pneumothorax after PTNA, we tried Histoacryl^(®) injection through biopsy needle after aspiration of specimen. Histoacryl^(®) is a deriative of cyanoacrylate and used as a tissue adhesive. Such effect of Histoacryl^(®) observed on PTNA model of rabbits. Material and methods; In 40 adult rabbits(20 contral group. 20 study group), intramuscular injection of ketamine 15㎎/㎏ for anesthesia and 3㎜ endotracheal intubation tube was inserted in the trachea after tracheostomy. Ambu-bagging with 10㎜Hg end expiratory pressure was started. On the supine position, routine percutaneous transthoracic needle aspiration was performed in control group. In study group, Histioacryl^(®) was injected into lung parenchym at 6th intercostal space on midclavicular line before needle withdrawl. Depth of needle was 1.5㎝ and PTNA sites were in 10 cases, right and 10 cases, left in each group. The amounts of injected Histoacryl^(®) was 0.1㏄ in 7 cases, 0.2㏄ in 7 cases, 0.4 ㏄ in 6 cases. After 10 minutes, HRCT was done and inspected pneumothorax amount and rechecked HRCT after 7 days. Rabbits were sacrified and histopathologic evaluation was done after 7 days. Result; Pneumothorax developed 19 cases in control group and just 4 cases in study group. Control group is developed much higher incidence and severity of pneumothorax than that of study group. Increased amount of Histioacryl^(®) substance is not effective to prevent the pneumothorax and more complicated result on follow-up study. Histopathologic findings were revealed a little inflamatory reaction and lung parenchymal fibrosis and pleural adhesion. Conclusion; In animal study of artificial COPD lung condition, Histioacryl^(®) injection is effective to prevent the pneumothorax after PTNA.

모체의 염색체 균형전좌를 가진 환아들의임상적 세포 유전학적 관찰

임한혁,정희정,박경덕,김숙자 대한소아청소년과학회 2005 Clinical and Experimental Pediatrics (CEP) Vol.48 No.7

Purpose : Parents' genetic information plays an important role in their children's genetic expression. Human chromosome has 23-paternal chromosomes and 23-maternal chromosomes. Parental chromosomal translocation can induce clinical problems in their children because of imbalance in genetic information. We intent to analyze the cytogenentic and clinical features about children with maternal balanced translocation between chromosome 15 and 18. Methods : We detected by one family's FISH study of chromosome 15. We have evaluated children born to clinically normal parents about peripheral bood analysis, endocrine, metabolic, radiologic study, electroencephalogram and social & intelligence scale. and We analysis their clinical manifestation by hospital records. Results : Patient's father and elder sister are normal clinically and genetically. Her mother's chromosome show balanced translocation, 46, XX, t(15;18)(p11.2;p11.3). One child has 46, XX, der(18) t(15;18)(p11.2;p11.3), mental retardation, growth retardation, speech & social developmental delay, recurrent infection and mild mitochondria dysfunction. Her young brother has 46, XY, der(15) t(15;18) (p11.2;p11.3), mental retardation, aggressive behavior, obesity and speech developmental delay. Conclusion : In this study we observed the children with developmental delay, dysmorphic facial features, mental retardation, growth retardation associated with growth hormone deficiency and aggressive behavior due to unbalanced translocation between chromosome 15 and 18 목 적 : 부모에게서 받은 유전정보는 자손의 유전표현에 필수적인 역할을 한다. 만일 어머니나 아버지로부터 받는 유전자가 서로 전좌가 일어날 경우 자손에게 부여되는 유전정보는 충분하지 않거나 필요이상으로 많이 받게 되어 자손에게 임상적 문제점을 일으킬 수가 있다. 임상적으로 정상인 부모로부터 태어나 정신발달이상과 행동발달지연을 보인 한 가족의 세포 유전학적인 연구와 임상 소견들을 관찰하여 원인규명과 앞으로의 예후를 평가할 목적으로 이 연구를 실시하였다.방 법 : 대상 환아는 충남대학교병원 소아과에 입원한 11세의 여아와 가족의 총 5명으로 하였다. 환자의 병력청취와 이학적 검사, 가족력조사를 시행하였으며 원인을 밝히기 위하여 염색체 분석, FISH, 대사질환 분석, 정신 사회학적 검사인 소아정신과 상담과 치료받은 기록 및 사회성숙도 검사, 심리평가, EEG를 실시하였고, 성장발달검사를 위해 혈액검사와 방사선학적 검사, 내분비 검사를 시행하였다.결 과 : 염색체 검사는 환아의 아버지와 언니는 정상이었고 환아의 어머니는 임상적으로 정상이었지만, 46, XX. t(15,18) (p11.2;p11.3)을 보였고, 남동생은 복부비만, 과식, 난폭한 행동, 괴성, 주의력 산만, 학습장애, 언어 발달 지연 등의 임상 소견을 보이면서 46, XY der(15) t(15;18)(p11.2;p11.3)이며 환아는 46, XX. der(18) t(15;18)(p11.2;p11.3)로 대사이상 검사상 미토콘드리아 기능 저하를 의심할 수 있는 소견과 내분비 검사상 성장호르몬 결핍소견을 보였고, 운동 및 신경정신과적 발달 검사상 행동발달 지연, 언어발달 지연, 사회성 발달지연 및 중등도의 정신지체를 보였다.결 론:정상인 아버지와 임상적으로 정상이면서 균형전좌(balanced translocation)인 46, XX. t(15,18)(p11.2;p11.3)를 갖는 어머니로부터 태어난 자녀들이 염색체 15번 장완과 18번 장완의 비균형 전좌(unbalanced translocation)로 인해 이형성(dysmorphogenesis)을 유발하고, 뇌의 전반적인 기능저하, 얼굴모양의 기형, 성장지연, 면역력의 저하 등 다양한 임상소견을 보임을 알 수 있었다

소아 하기도 호흡기 감염에서 항생제 치료 가이드라인으로서의 혈청 procalcitonin의 임상적 유용성

임한혁,강혜진,양은애,이재호 대한 소아알레르기 호흡기학회 2012 Allergy Asthma & Respiratory Disease Vol.22 No.1

Purpose:Procalcitonin (PCT), a precursor of calcitonin, has been described as a biomarker of bacterial infection and inflammation. This study was performed to evaluate the clinical usefulness of PCT levels and to reduce the unnecessary usage of antibiotics in children with lower respiratory tract infection (RTI). Methods:Eighty-eight children, with lower RTI, under the age of 5 years, who were admitted to Chungnam National University Hospital, between May 2010 and December 2010, were enrolled. White blood cell counts, erythrocyte sedimentation rate, C-reactive protein, and PCT were measured. Blood and sputum cultures were performed to identify the causative bacteria and reverse transcription-polymerase chain reaction for the viruses. Clinical features were reviewed, retrospectively. Results:The mean participant age was 1.9±1.5 years. The cut-off value for serum PCT levels, which was derived from the receiver-operator characteristic curve, was 0.11 ng/mL. In 29 patients (33.0%) with low PCT levels (<0.11 ng/mL), antibiotic therapy showed no benefit for clinical and laboratory findings. However, in 59 patients (67.1%) with high PCT levels (≥0.11 ng/mL), hospitalization (P=0.005) and fever (P=0.054) exhibited a shorter duration, after antibiotic therapy. Conclusion:A single initial serum PCT levels (≥0.11 ng/mL) may be clinically useful to give a guideline for antibiotic treatment in children with lower respiratory tract infection and to reduce the unnecessary usage of antibiotics. 목 적:칼시토닌의 전구 물질인 혈청 procalcitonin (PCT)은 세균성 감염 및 염증 반응의 새로운 표지자로 제안되어 이에 본 연구는 항생제의 불필요한 사용을 예방하기 위해 소아의 하기도 호흡기 감염에서 혈청 PCT의 임상적 유용성을 알아보고자 한다. 방 법:2010년 3월부터 2010년 12월까지 충남대학교 병원 소아청소년과에 입원하여 하기도 호흡기 감염으로 치료받은 5세 미만의 환아 88명을 대상으로 하였다. 입원 당시 말초혈액 백혈구 수, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), PCT을 측정하였고, 원인균 확인을 위해 입원 당시 혈액배양 검사 및 바이러스 다중 역전사 중합효소 연쇄반응(reverse transcription- polymerase chain reaction) 검사를 시행하였다. 임상 양상은 후향적으로 조사하였다. 결 과:대상 환아의 평균 나이는 1.9±1.5세였다. Receiver operating characteristic 곡선에서 PCT 값의 cut-off값은 0.11 ng/mL이었다. 혈청 PCT 값이 0.11 ng/mL 미만으로서 혈청 PCT 값이 낮은 군으로 분류된 29명 환아에서 항생제 사용 유무에 따른 임상 증상, 말초혈액 백혈구 수, ESR 및 CRP 값은 유의한 차이를 보이지 않았다. 반면, 혈청 PCT 값이 높은 군(PCT≥0.11 ng/mL)에서 항생제 사용이 환자들의 입원 기간(P=0.005)과 입원 후 발열 기간(P= 0.054)을 호전시키는데 도움이 되었다. 결 론:소아 하기도 호흡기 감염에서 혈청 PCT 측정값(0.11 ng/mL)이 항생제 치료 여부를 결정하는데 필요한 요소로 활용되고, 불필요한 항생제 사용을 감소시키는데 기여할 것으로 기대된다.

Clinical and Laboratory Findings of Benign Acute Childhood Myositis

임한혁,김지나,강준원,김재영,이건수 대한소아신경학회 2010 대한소아신경학회지 Vol.18 No.2

Purpose:Benign acute childhood myositis (BACM) is a rare condition, characterized by severe lower extremity pain and acute-onset reluctance to walk in children. This study evaluated the clinical course of and laboratory findings related to BACM. Methods:Patients with gait disturbance who had visited the Department of Pediatrics, Chungnam National University Hospital between March 2010 and May 2010 and who had been diagnosed with BACM were enrolled. The patients' medical records were examined retrospectively, and the clinical and laboratory data were recorded. Results:Seven patients (six boys and one girl) were enrolled. Their median age was 7.3 years old. Four patients had leucopenia and five had mild thrombocytopenia and six had elevation of serum aspartate aminotransferase or alanine aminotransferase levels, or both. The median serum creatine phosphokinase level was 1,864 IU/L, (range 368-7,166 IU/L). All patients had elevated lactate dehydrogenase and no patients studied had any evidence of bacterial infections. Influenza B virus was detected in two patients. and all patients spontaneously recovered after one week. Conclusion:Self-limited BACM should be considered if acute gait disturbances with calf pain and elevated serum creatine phosphokinase levels are observed in otherwise healthy children with no neurological abnormalities.

Commentary on "Effects of once-weekly dulaglutide on juvenile type 2 diabetes mellitus and obesity in Korea: a pilot study"

임한혁 대한소아내분비학회 2023 Annals of Pediatirc Endocrinology & Metabolism Vol.28 No.4