소아 세균수막염에서 경막하삼출 합병증의 임상적 특징

엄태민(Tae Min Um),김용석(Yong Seok Kim),연규민(Gyu Min Yeon),남상욱(Sang Ook Nam),김영미(Young Mi Kim),이윤진(Yun-Jin Lee) 대한소아신경학회 2012 대한소아신경학회지 Vol.20 No.3

목 적 : 저자들은 세균수막염으로 치료한 환자들에서 경막하삼출이 합병되었던 환자들의 임상적 특징 및 관련 인자를 조사하고자 하였다. 방 법 : 2006년부터 2011년까지 부산대학교 어린이병원에 세균수막염으로 치료받은 86명의 소아중뇌 MRI를 시행하였던 63명의 환자들을 대상으로 하여 전체 환자들을 경막하삼출이 동반되었던 군(A군, 13명)과 정상군(B군, 50명)으로 분류하였다. 진단시 나이, 처음 병원 방문시의 증상들과 지속기간, 치료 중 증상의 호전 및 악화 여부, 검사실 소견, 치료 약물 과 치료기간, 뇌 MRI와 뇌파 소견, 신경학적 후유증을 후향적으로 조사하였고, 두 군 사이에서 비교 분석하였다. 결 과 : A군의 진단 시 평균 연령(4.9±10.1개월)이 B군(27.2±46.5개월)에 비해 어린 경향이었다( P=0.046). 처음 증상들 중, 발열이 두 군 모두에서 가장 많았고, A군에서 경련(A군; 30.8%, B군; 8.0%, P=0.028)과 기면 상태(A군; 38.5%, B군; 16.0%, P=0.070)가 B군에 비해 더 흔히 관찰되었다. 항생제 치료시작 이후 초기 증상의 지속기간을 두 군 사이에서 비교했을 때, 특히 구토(A군; 2.5±1.5일, B군; 1.1±0.3일, P=0.003)와 보챔(A군; 2.5±1.5일, B군; 1.1±0.3일, P=0.034)의 지속기간이 A군에서 더 길었다. 처음 진단 당시의 검사실 소견에서 A군이 B군에 비해 CRP (A군; 9.4±8.6 mg/dL, B군; 4.1±6.6 mg/dL, P=0.010), 뇌척수액의 호중구 비율(A군; 71.2±16.4%, B군; 54.1±33.4%, P=0.041) 및 단백(A군; 260.2±192.5mg/dL, B군; 119.9±148.5 mg/dL, P=0.003)이 의미 있게 높았고, 뇌척수액의 당(A군; 34.8±19.9mg/dL, B군; 46.2±13.6 mg/dL, P=0.011)은 명백히 낮았다. 치료 중 추적검사로 CRP (A군; 9.3±10.4 mg/dL, B군; 2.7±5.5 mg/dL, P=0.011)와 뇌척수액의 세포수(A군; 670.6±101.4/㎣ , B군;123.5±243.8/㎣, P=0.006) 및 단백(A군;211.5±148.3 mg/dL, B군; 82.1±85.8 mg/dL, P=0.002)이 A군에서 지속적으로 의미 있게 증가되어 있었다. 뇌척수액 균배양 양성율도 A군에서(A군;46.2%, B군; 4.0%, P<0.001) 의미 있게 높았고 가장 많이 배양된 균은 S. agalactiae (4/13, 30.8%)였다. 뇌파검사는 비정상 소견이 A군에서(A군; 46.2%, B군; 12.0%, P=0.005) 더 흔히 관찰되었다. A군의 약물치료 기간(A군; 22.3±9.0일, B군;13.2±6.2일, P<0.001)이 B군에 비해 의미있게 길었으나, 신경학적 합병증 없이 모두 완치되었다. 결 론 : 소아 세균수막염 치료 시 특히 어린 영유아일 때 초기 증상으로 경련, 기면상태가 관찰되거나 항생제 치료 시작 후에 구토나 보챔이 지속되는 경우에는 경막하삼출 발생 여부를 조사하여 조기에 진단함으로써 이후 발생 가능한 신경학적 합병증의 예측, 관찰 하는데 도움이 될 것이다. Purpose : Authors aim to examine the clinical characteristics and relevant factors of the bacterial meningitis with the complication of subdural effusion. Methods : We identified the 63 children with bacterial meningitis from 2006 to 2011. Thirteen children (group A) had a complication of subdural effusion during the treatment and 50 children (group B) did not. We reviewed their medical records retrospectively regarding demographic profiles, clinical features and laboratory findings. Results : The mean age was younger in group A than in group B (4.9±10.1 vs 27.2±46.5 months, P=0.046). Of the initial symptoms, fever was the most frequent symptom, while seizures (30.8% vs 8.0%, P=0.028) and lethargy (38.5% vs 16.0%, P=0.070) were more common in group A. Since the antibiotics medication, the duration of vomiting (2.5±1.5 vs 1.1±0.3 days, P=0.003) and irritability (2.5±1.5 vs 1.1±0.3 days, P=0.034) was longer in group A. Initial laboratory findings were significantly different between two groups with elevation of CRP (9.4±8.6 vs 4.1±6.6 mg/dL, P=0.010), CSF neutrophil ratio (71.2±16.4 vs 54.1±33.4%, P=0.041), and CSF protein (260.2±192.5 vs 119.9±148.5 mg/dL, P=0.003) in group A. Follow-up examination showed that CRP (9.3±10.4 vs 2.7±5.5 mg/dL, P=0.011), CSF cell count (670.6±1,014.0 vs 123.5±243.8 /㎣, P=0.006), and CSF protein (211.5±148.3 vs 82.1±85.8 mg/dL, P=0.002) were significantly higher in group A. Conclusion : Some significantly different results were shown in the comparison of initial symptoms and their durations and laboratory findings between the patients with subdural effusion following bacterial meningitis and those without subdural effusion.

무선통신망을 이용한 자율이동로봇에 관한연구

유민석(Min-Suck yoo),엄태민(Tae-Min Um),김남욱(Nam-Uook Kim),최은진(Eun-jin Choi),나유청(yoo-chung Na),홍선기(Sun-Ki Hong) 대한전기학회 2011 대한전기학회 학술대회 논문집 Vol.2011 No.7

보조 스위치를 사용한 ZVS Two-Switch 포워드 컨버터에 대한 연구

정민혁(Min-Hyuk Jung),김용(Yong Kim),엄태민(Tae-Min Um),이규훈(Kyu-Hun Lee),이동현(Dong-Hyun Lee) 대한전기학회 2009 대한전기학회 학술대회 논문집 Vol.2009 No.7

In this paper, a new soft-switching Two-switch Forward converter topology has been proposed. Compared with conventional two-switch forward converter, the proposed converter employs an auxiliary switch and a clamp capacitor to instead of two reset diodes, not only its duty cycle can exceed 0.5 to achieve wide range input voltage, but also soft switching can be achieved for all switches. Especially, voltage stress across main switches can be clamped at 1/2V<SUB>in</SUB>, voltage stress across auxiliary switch can be clamped at V<SUB>in</SUB>. In addition, due to clamp capacitor series with the transformer, duty ratio can be extended with equation [수식삽입]. Therefore, as a kind of better cost-effective approach, it is very attractive for high input, wide range and high efficiency application.

최근 3년간 기저질환이 없는 소아 입원 환자에서 호흡기 바이러스에 따른 급성 하기도 감염의 임상적 특징

서민해 ( Min Hae Seo ),김형영 ( Hyung Young Kim ),엄태민 ( Tae Min Um ),김혜영 ( Hye-young Kim ),박희주 ( Hee-ju Park ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.2

Background: Respiratory viruses play a significant role in the etiology of acute respiratory infections and exacerbation of chronic respiratory illnesses. This study was conducted to identify the epidemiological and clinical characteristics of children with acute viral lower respiratory infections. Methods: This study investigated 1,168 children diagnosed with acute viral lower respiratory tract infections (RTIs) between January 2012 and December 2014. Specimens of respiratory viruses were collected using a nasopharyngeal swab and analyzed by reverse transcriptase polymerase chain reaction. We retrospectively reviewed the medical records and analyzed the clinical features of children hospitalized for acute lower respiratory infections. Results: Respiratory syncytial virus (RSV), the main cause of infection in children aged <5 years, was the most commonly detected pathogen in children with bronchiolitis and pneumonia, and resulted in high proportions of children requiring oxygen treatment and intensive care unit admission. Rhinovirus was preceded by RSV as the second most common cause of bronchiolitis and pneumonia, and was detected most frequently in the children aged ≥6 years. In addition, asthma was predominantly caused by rhinovirus in children aged ≥6 years, whereas croup was mostly caused by parainfluenza virus in those aged <5 years. Rhinovirus infection (p<0.001) and history of asthma (p=0.049) were identified as significant risk factors for readmission within a month. Conclusion: We identified the epidemiological and clinical characteristics of respiratory viruses in children with acute lower respiratory infections during the last 3 years. Our findings may provide useful clinical insight to comprehend the acute viral lower RTIs in children.

전산화 단층 촬영을 통해 발견된 소아 기관기관지(Tracheal Bronchus)의 임상적 고찰

김용석 ( Yong Seok Kim ),엄태민 ( Tae Min Um ),손승국 ( Seung Kook Son ),김혜영 ( Hye Young Kim ),김용우 ( Yong Woo Kim ),박희주 ( Hee Ju Park ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.4

목 적 : 기관기관지는 기관분기부 상부의 기관의 측벽에서 기원하는 이소성 기관지로, 대개 무증상으로 우연히 발견되며, 다른 기형과 동반되는 경우가 많다. 본 연구에서는 기관기관지의 임상 양상에 대해서 알아보고자 한다. 방 법 : 2000년 1월부터 2011년 12월까지 흉부 전산화단층 촬영 스캔을 실시하여 기관기관지로 진단된 19례를 대상으로 이들의 증상, 방사선학적 소견, 동반 기형의 유무 등 임상 양상을 후향적으로 조사하였다. 결 과 : 기관기관지로 진단될 때 나이는 2일부터 14세까지(평균 51개월)였으며, 남아가 12명(63.2%), 여아가 7명(36.8%)이었다. 우측 기관기관지가 18명(94.7%), 좌측 기관기관지가 1명(5.3%)으로 대부분 우측에서 기원하였고, 기관지의 수에 따라 전위형이 14명(73.7%), 과다형이 5명(26.3%)으로 전위형이 많았다. 증상은 없는 경우가 13명(68.4%)이었고, 기침 5명(26.3%), 반복적 천명이 4명(21.1%)에서 관찰되었다. 동반기형은 17명(89.5%)에서 확인되었고, 선천 심혈관계 기형이 16명(84.2%), 기관-식도루 3명(15.8%), 다운증후군 2명(10.5%)이었다. 결 론 : 기관기관지 환자에서 호흡기계 증상은 심하지 않았으나, 다른 동반 기형들이 많이 발견되었다. 따라서 반복되는 천명과 같은 증상이 있는 경우 기관기관지 여부를 확인하고, 기관기관지로 진단된 경우에는 동반 기형 여부 등에 대한 평가가 필요하겠다. 본 연구는 연구 대상에 심혈관계 기형을 가진 환자의 빈도(84.2%)가 높아 한계를 가진다. Purpose : Tracheal bronchus is an aberrant bronchus arising from tracheal wall above the carina. Most cases of tracheal bronchus are asymptomatic, so they are diagnosed incidentally. Tracheal bronchus may be associated with other anomalies. The aim of this study is to evaluate the clinical characteristics of tracheal bronchus. Methods : This study was conducted on 19 children who were diagnosed as tracheal bronchus by the chest computed tomography from January 2000 to December 2011. Based on the medical record, clinical features, such as symptoms, radiologic findings, combined anomalies were evaluated retrospectively. Results : The age at diagnosis was ranged from 2 day to 14 years (mean, 51 months). Among the 19 children, twelve children (63.2%) were boys and seven children (36.8%) were girls. Eighteen children (94.7%) had right-side tracheal bronchus and one child (5.3%) had left-side tracheal bronchus. Displaced type were fourteen children (73.7%), supernumerary type were five children (26.3%). Thirteen children (68.4%) had no respiratory symptoms, but five children (26.3%) had persistent cough and four children (21.1%) had recurrent wheezing. Combined congenital abnormalities were present in seventeen children (89.5%), including congenital cardiovascular anomaly (n=14, 73.7%), trachea-esophageal fistula (n=3, 15.8%), Down syndrome (n=2, 10.5%). Conclusion : The patients with tracheal bronchus had not severe respiratory symptoms, but had many combined anomalies. So, it is necessary to consider the presence of tracheal bronchus in children with respiratory symptom, like recurrent wheezing, and to evaluate clinical significance, like combined anomaly, in tracheal bronchus patients. The limitation of this study is that the study group includes many cardiovascular disease patients (84.2%). [Pediatr Allergy Respir Dis(Korea) 2012;22:411-416]

중풍과 함께 발병한 불면증 환자의 치험 1례

박혜진 ( Hea Jin Park ),백인경 ( In Kyung Back ),엄태민 ( Tae Min Um ),류호룡 ( Ho Ryong Ryu ),김윤식 ( Yoon Sik Kim ),설인찬 ( In Chan Sul ),조현경 ( Hyun Kyung Jo ) 대전대학교 한의학연구소 2014 한의학연구소 논문집 Vol.22 No.2

Objective : Western sleeping pills work very fast and effectively against insomnia. But they also bring about many side effects. Therefore oriental medicine can be a good alternative remedy. There are many clinical reports about patients treated for insomnia after stroke using oriental medicine. However, there are no clinical report about patients treated for insomnia after stroke diagnosed by Gobub & Bokjin. We want to prove the effect of Gobub & Bokjin in diagnosis and treatment for the insomnia patients after stroke. Methods : We chosed a patient who had suffered from insomnia after stroke. We administered acupuncture treatment, as well as Herbal medicine(Bokryoungum and Sanjoinsan). We monitored total sleep time per a day for 23 days. Results & Conclusion : Bokryoungum and Sanjoinsan was effective in improving overall sleep time day.