소아 담석증에 대한 임상적 연구

은호선,백승연,정기섭,Eun, Ho Seon,Baek, Seoung Yon,Chung, Ki Sup 대한소아소화기영양학회 2005 Pediatric gastroenterology, hepatology & nutrition Vol.8 No.2

목 적: 소아에서 담석증은 성인에 비해 드문 질환이며, 여아에서 호발하고, 전형적인 증상은 드물 어서 나이가 어릴수록 무증상일 가능성이 높다. 원인으로 구상적혈구증, 복부 수술, 항생제(ceftriaxone), 감염 등에 의하여 유발되기도 하며, 유전 요인, 환경적 요인 등에 의해서도 영향을 받는 것으로 알려져 있다. 그러나 현재 우리나라에서 소아의 담석증에 대한 연구 보고는 드물다. 이에 저자들은 연세의대 소아과에 내원하여 담석증으로 진단 받은 환아들을 대상으로 임상적 특성을 알아보고자 본 연구를 시행하였다. 방 법: 1999년 1월 1일부터 2005년 5월 31일까지 본 병원 소아과에 내원하여 담석증으로 진단 받은 15세 이하의 환아 총 18예를 대상으로 조사 분석하였다. 대상 환아는 복부 초음파 검사 또는 복부 CT 검사에서 담석증으로 확진된 경우만으로 하였고, 이러한 영상검사를 시행하지 않았거나 담낭잔사를 보인 환아는 대상에서 제외하였다. 결 과: 대상 환아는 남아 12예, 여아 6예로 남녀 비는 2:1이었고, 연령별 분포는 최소 4개월부터 최대 13년 3개월 된 환아까지 다양하였다. 전체 평균은 $6{\pm}4.3$세였고, 남아는 $6.1{\pm}3.9$세, 여아는 $5.8{\pm}5.6$세로 큰 차이는 없었다. 담석증에 의한 증상은 18예 중 3예(16.7%)에서 고열, 복통, 구토 등이 있었고, 나머지 15예(83.3%)에서는 증상이 없었다. 이러한 증상은 남녀간에 차이가 없었고, 연령이 많을수록 나타나는 경향을 보였다. 총 18예 중 15예(83.3%)에서 유발 요인이 있었는데, 항생제(ceftriaxone) 투여가 6예(33.3%), 감염이 4예(22.2%), 구상적혈구증이 3예(16.7%), Down 증후군과 복부 수술이 1예(5.6%)에서 각각 있었다. 담석의 크기는 17예 중 15예(88.2%)가 5 mm 이하의 담석으로 가장 많았고, 다음으로 5~10 mm가 2예(11.8%)였고, 10mm 이상은 없었다. 담석의 수는 단발(single)과 다발(multiple)이 각각 14예(77.8%), 4예(22.2%)로 단발성 담석이 많았다. 말초혈액도말 검사상 백혈구증다증, 고콜레스테롤 혈증, 고칼슘 혈증을 보인 환아는 없었으나, 2예에서 철결핍성 빈혈이 있었다. 혈청 AST 및 ALT는 7예(58.3%)에서 증가되었는데, 이 중 전염성 단핵구증에 감염된 환아는 2예로 이 중 1예는 혈청 빌리루빈치가 약간 상승되어 있었고, 마이코플라즈마에 감염된 1예는 급성 췌장염이 합병되어 혈청 amylase 및 lipase가 상승되어 있었으며, 1예는 캔디다 감염이 동반되어 있었다. 치료는 18예 중 17예(94.4%)에서 보존적 치료를 하였으며 주기적으로 복부 초음파를 시행하면서 추적 관찰하였다. 수술은 Meckel 게실이 동반되었던 1예에서 담낭 적출술을 시행하였다. 추적 관찰하였던 환아 17예 중 13예에서 복부 초음파상 담석이 소실되었고, 3예는 추적 관찰 중이며, 나머지 1예는 추적 관찰에서 탈락되었다. 탈락된 1예를 제외한 17예 모든 환아에서 재발이나 합병증은 없었다. 결 론: 본 연구 결과 소아 담석증은 남아에서 호발하고, 어릴수록 무증상이 많다. 유발요인이 있는 환아가 많았고, 크기가 작은 단일석이 대부분이었다. 치료는 대부분 보존적 치료를 하였다. 최근 영상진단의학이 발달함에 따라 소아에서도 담석증의 발견율이 높아지고 있다. 그러나 우리나라에서 소아 담석증에 대한 연구보고는 드물다. 따라서 소아 담석증 환아에서 성인과 다른 특성과 또한 유발 요인 등을 비롯한 외국 환아와의 임상적 차이점 등을 알아보기 위하여 이에 대한 연구가 더 필요할 것으로 생각된다. Purpose: Gall bladder (GB) stones in children are rarely observed, and so reports of them have been quite limited in Korea. Therefore, we tried to assess the epidemiology and clinical features of children with GB stone diagnosed at Severance Hospital. Methods: A clinical study was performed on 18 patients below 15 years of age diagnosed with GB stone by abdominal ultrasonography or CT scan at Severance hospital from January 1999 to May 2005. Results: Concerning patients' profile, their sex ratio of male to female in total 18 cases was 2 : 1 with the mean age of $6{\pm}4.3years$. 15 patients (83.3%) were asymptomatic. Inducing factors were found in 14 children (77.8%) including ceftriaxone therapy in 6 cases (33.3%), infection in 4 cases (22.2%), spherocytosis in 3 cases (16.7%), Down syndrome and abdominal operation in 1 case (5.6%) respectively. Single stone was found in 13 cases (76.5%) and multiple in 4 cases (23.5%). 15 cases (88.2%) had the stones less than 5 mm in size, and 2 cases (11.8%) between 5 and 10 mm. 17 patients received conservative treatment, and one patient had cholecystectomy due to Meckel diverticulum. Conclusion: In this report, Pediatric GB stones are predominant in male children, without typical symptoms, having inducing factors, single and small. Recently the diagnosis of them has been increased because of the development of imaging study. But the reports for them were still rare in Korea. Therefore the study for them is more necessary to find it's clinical characteristics.

미숙아에서 장막층의 섬유 끈에 의한 선천적 위 출구 폐쇄 1례

양소민 ( So Min Yang ),은호선 ( Ho Seon Eun ),이순민 ( Soon Min Lee ),장혜경 ( He Kyung Chang ),박국인 ( Kook In Park ),남궁란 ( Gung Ran Nam ) 대한주산의학회 2014 Perinatology Vol.25 No.4

Most of the gastric outlet obstruction symptoms like vomiting and abdominal distension were caused bycongenital anatomical abnormality in a neonate. Abnormal structures associated with congenital gastricoutlet obstruction have been categorized by its site and extent of obstruction. We report one case of persistingvomiting in a premature infant caused by serosal fibrous band in gastric outlet lesion, excluded from thecategory of congenital gastric outlet obstruction.

중환자실 재원 소아환자의 영양집중지원팀 자문 순응도에 따른 영양공급 중재 효과

박수진 ( Soo-jin Park ),박지은 ( Ji-eun Park ),권나영 ( Na-young Kwon ),김재송 ( Jae-song Kim ),손은선 ( Eun-sun Son ),유현지 ( Hyun-ji Yu ),방제연 ( Jae-yeon Bang ),김승 ( Seung Kim ),은호선 ( Ho-seon Eun ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.2

Purpose: This study performed a comparative evaluation of nutritional condition’s improvement and clinical effects in accordance with the Nutrition Support Team (NST) consultation compliance of critically ill pediatric patients. Methods: The medical records of 64 critically ill pediatric patients (2 to 18 years old), who were officially referred to a NST consultant in pediatric intensive care unit from January to August 2015, were reviewed. The patients were divided into 2 groups according to the compliance of NST consultation answers. The total delivered/required caloric and protein ratio, weight, serum total protein, serum albumin, hemoglobin, and hematocrit were compared. Results: According to the NST consultation answer, ‘nutrition support increase’ occupied the largest proportion at 38.5%; ‘maintenance’ and ‘decrease’ accounted for 35.7% and 18.2% respectively. The NST compliance group and non-compliance group were 20 and 14 patients, respectively. Although total delivered/required caloric ratio was significantly increased in the NST compliance group (19.7%, P=0.036), there was no significant difference in the NST non-compliance group (5.1%, P=0.692). The total delivered/required protein ratio was increased (15.1%, P=0.163) in the NST compliance group and decreased (-4.7%, P=0.774) in the NST non-compliance group. The NST non-compliance group (-8.6%, P=0.219) was further reduced weight than the NST compliance group (-1.0%, P=0.820). The serum albumin was significantly increased in the NST compliance group (13.1%, P=0.003), but there was no difference in the NST non-compliance group (7.1%, P=0.433). Conclusion: Although 56.7% of NST consultations were needed for nutritional interventions, a lower NST compliance (53.8%) is the limit of nutritional support. The NST compliance group was supplied adequately with more calories and protein than before consultation and a more improved nutritional status. Therefore, aggressive NST consultation can help increase the therapeutic effect by improving the nutritional status. This study will form the basis to seek ways to further enhance NST compliance.

신생아 환자에서 지방 유제 사용 시 어유 함유 여부에 따른 Parenteral Nutrition-Associated Liver Disease 발생 정도 분석

박정아 ( Jeong-a Park ),박지은 ( Ji-eun Park ),정민재 ( Min-jae Jeong ),김재송 ( Jae-song Kim ),손은선 ( Eun-sun Son ),은호선 ( Ho-seon Eun ) 한국정맥경장영양학회 2017 한국정맥경장영양학회지 Vol.9 No.1

Purpose: This study is a comparative evaluation of the incidence of parenteral nutrition-associated liver disease (PNALD) when administering intravenous fat emulsions containing fish oil. Methods: The medical records of patients who were in the neonatal intensive care unit at Severance Hospital from January, 2012 to December 2015, were reviewed retrospectively. Patients who were administered either soybean oil (SO) or SMOF (containing soybean oil, medium chain triglycerides, olive oil, and fish oil) more than 14 days were included. The patients were excluded if they were administered both agents or had underlying hepatic disease. An increase in bilirubin to 2 mg/dL was defined as PNALD. Results: PNALD occurred in only 8 out of a total of 77 patients: 6 out of 31 (19.4%) in the SO group and 2 out of 46 (4.3%) in the SMOF group (P=0.055). The number of patients, whose lab values, such as direct bilirubin, total bilirubin, asparate aminotransferase (AST), alanine amino-transferase, gamma-glutamyl transpeptidase, C-reactive protein, serum triglyceride, and alkaline phosphate, exceeded the normal range, were similar in both groups. The gestational age, birth body weight, and APGAR score at 1 min and 5 min were significantly higher in the SO group and the PN duration was significantly long in the SMOF group. Considering only term infants, there were no significant differences in baseline characteristics and incidence of PNALD. The number of patients whose AST exceeded the normal range was significantly higher in the SO group (P=0.034). Conclusion: The incidence of PNALD was similar in both groups. On the other hand, considering the tendency, there was a high correlation between the type of lipid emulsion and an increased direct bilirubin level in the SO group.

일산화질소 흡입요법에 반응하지 않는 중증 신생아 지속성 폐동맥 고혈압증 환자에서 분무식 iloprost (Ventavis(R))의 치료효과

한윤기 ( Yoon Ki Han ),이순민 ( Soon Min Lee ),은호선 ( Ho Seon Eun ),김정은 ( Jeong Eun Kim ),남궁란 ( Ran Namgung ),박민수 ( Min Soo Park ),박국인 ( Kook In Park ),이철 ( Chul Lee ) 대한주산의학회 2011 Perinatology Vol.22 No.1

Inhaled iloprost, a stable carbacyline derivative of prostacyclin, has been used recently for the treatment of adults with pulmonary hypertension but only few reports are available about its use in neonatal critical care. We report therapeutic trial of inhaled iloprost in newborn infants with persistent pulmonary hypertension of the newborn (PPHN) who did not respond to inhaled nitric oxide (iNO). Inhaled iloprost (Ventavis(R), Bayer Shering Pharma, Germany) was effective in neonates with severe PPHN who showed inadequate response to iNO. We suggest that inhaled iloprost could be considered as an additional therapeutic option in PPHN refractory to iNO.

기관지폐이형성증 영아에서 폐기능 측정의 유용성

김경원 ( Kyung Won Kim ),최봉석 ( Bong Seok Choi ),이용주 ( Yong Ju Lee ),은호선 ( Ho Seon Eun ),손명현 ( Myung Hyun Sohn ),박국인 ( Kook In Park ),남궁란 ( Gung Ran Nam ),이철 ( Chul Lee ),김규언 ( Kyu Earn Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2010 소아알레르기 및 호흡기학회지 Vol.20 No.1

목적: 건강한 미숙아에서 기관지폐이형성증을 가진 미숙아에 이르기까지 미숙아의 폐기능은 다양한 정도로 감소되어 있다고 알려져 있다. 영아에서 폐기능을 평가하는 방법은 오랜 노력 끝에 표준화되기에 이르렀으나 국내에서 아직까지 연구된 바 없다. 본 연구에서는 만성 폐질환을 가진 미숙아에서 폐기능을 객관적인 평가방법을 통하여 측정하고 폐기능 감소에 영향을 미치는 위험 요인들을 분석하여 그 유용성을 알아보고자 하였다. 방법: 세브란스 어린이병원에서 출생한 54명을 대상으로 하였다. 전체 대상아 중 남자는 31명, 여자는 23명이었고, 평균연령은 5.6±3.7개월이었다. 대상자에서 영아폐기능 측정기구(Exhalyser; EcoMedics, Du rnten, Switzer-land)를 이용하여 일회호흡량(tidal volume, TV) 및 기능적잔기량(functional Residual Capacity, FRC)을 측정하였고, 기관지확장제 흡입 후 같은 방법으로 측정하여 변화를 관찰하였다. 전체 대상아에서 검사와 관련된 부작용은 없었다. 결과: 대상 환아 54명 중 22명은 재태주령 28주 미만 출생아, 25명은 28주 이상 33주 미만 출생아, 7명은 33주 이상 37주 미만의 출생아였다. 또한 초극소 저체중출생아 23명, 극소 저체중출생아 23명, 저체중출생아는 8명이었다. 기관지확장제 흡입 전후 기능적잔기량 변화(delta FRC, dFRC)는 재태주령이 어릴수록(P<0.05), 출생체중이 작을수록(P<0.05) 의미있게 증가하였다. 기능적잔기량 변화는 재태주령(r=-0.35; P=0.013), 출생체중(r=-0.32; P=0.026)과 유의한 음의 상관관계를, 기계호흡일수(r=0.42; P =0.0028), 산소치료일수(r=0.43; P =0.0024)와는 양의 상관관계를 보였다. 기관지확장제 흡입 전 기능적잔기량은 출생체중이 작을수록 유의하게 작았으며, (r=0.43;P=0.0013) 기관지확장제 흡입 전 일회호흡량은 기계호흡일수와 음의 상관관계를 나타내었다. (r=-0.39; P=0.0048) 결론: 미숙아에서 출생체중이 작을수록, 재태주령이 어릴수록, 기계호흡일수와 산소치료일수가 길수록 기관지확장제에 의한 기능적잔기량의 가역성이 증가하였다. 기능적잔기량 가역성은 만성 폐질환 미숙아에서 안전하게 측정할 수 있는 유용한 폐기능 지표로 생각된다. Purpose: Pulmonary function is decreased in varying degrees in healthy premature infants as well as those with bronchopulmonary dysplasia. The evaluation of pulmonary function in infants is finally standardized after strenuous efforts, but it has not yet been in Korea. In this study, we aimed at the evaluation of the utility of pulmonary function tests in premature infants with chronic lung disease by objectively measuring pulmonary function and by analyzing the risk factors that may decrease lung function. Methods: Fifty-four premature infants born in Severance Hospital were selected. Among the 54 infants, 31 were male and 23 were female, and their mean age was 5.6±3.7 years. Exhalyser was used to measure tidal volume and functional residual capacity, and then their change after the inhalation of bronchodilators was evaluated. There was no test related complication in all subjects. Results: Among the 54 subjects, 22 were at the gestational age of <28 weeks, 25 were at the gestational age between 28 and 33 weeks, and 7 were at the gestational age between 33 and 37 weeks. As for birth weight, 23 had extreme low birth weight, 23 had very low birth weight, and 8 had low birth weight. The delta functional residual capacities (FRCs) before and after the inhalation of bronchodilator were significantly increased in infants with younger gestational age (P<0.05) and lower birth weight (P<0.05). There was a significant negative correlation between gestational age and birth weight, and a significant positive correlation with the duration of ventilator care and that of oxygen therapy. The delta FRC before the inhalation of bronchodilator was significantly lower in infants with lower birth weight, and the tidal volume before the inhalation of bronchodilator correlated negatively with the duration of ventilator care. Conclusion: The reversibility of FRC is increased in premature infants with lower birth weight, younger gestational age, and longer duration of ventilator care and oxygen therapy. The reversibility of FRC may be a useful parameter of pulmonary function that can be safely measured in premature infants with chronic lung disease. [Pediatr Allergy Respir Dis(Korea) 2010;20:68-75]

Angiotensin 2 Receptor Blocker를 사용한 산모로부터 출생 후 급성 신부전증을 보인 신생아 1례

이철 ( Chul Lee ),박민수 ( Min Soo Park ),박국인 ( Kook In Park ),남궁란 ( Ran Namgung ),이순민 ( Soon Min Lee ),은호선 ( Ho Seon Eun ),라정진 ( Jeong Jin Ra ) 대한주산의학회 2012 Perinatology Vol.23 No.4

Hypertension is common medical problem encountered during pregnancy. However medication administered for maternal hypertension may cause fetal or neonatal complications. Angiotensin converting enzyme inhibitor or angiotensin II receptor blocker are rarely used during pregnancy, and there are few reports about the effect of them, because administration of these drugs during pregnancy may cause oligohydramnios, renal tubular dysplasia, hypocalvaria, pulmonary hypoplasia, intrauterine growth retardation, neonatal anuria and persistent ductus arteriosus. We report a case of neonatal acute renal failure by angiotensin II receptor blocker during pregnancy. In this case, the neonate with meconium aspiration was admitted to neonatal intensive care unit (NICU). During the NICU stay, neonatal anuria occurred, and there was a medical history that his mother took Candesartan Cilexeril (Atacand(R)), one of angiotensin II receptor blockers during pregnancy. The neonate showed intrinsic acute renal failure, so fluid was restricted and diuretics were administered to the neonate, and after 10 days, anuria improved.