Comparison of the prevalence of islet autoantibodies according to age and disease duration in patients with type 1 diabetes mellitus

공영화,김민선,이대열 대한소아내분비학회 2013 Annals of Pediatirc Endocrinology & Metabolism Vol.18 No.2

Purpose: This study investigated the prevalence of islet autoantibodies in children and adults with T1DM according to their age and the duration of disease. Methods: We measured the levels of islet autoantibodies, including antiglutamic acid decarboxylase antibody (anti-GAD Ab), and combined these with anthropometric measurements and laboratory tests of 137 patients newly diagnosed with T1DM during the last 20 years. The subjects were subdivided into four groups according to their age at the onset of the disease. We then compared the prevalence of islet autoantibodies in the different age groups with the duration of disease. Results: Among the 137 patients, 68.9% tested positive for islet autoantibodies (71.4%within 1 year; 67.7% after 1 year of the disease onset). Within 1 year of the onset of the disease, 66.3% of the patients were positive for the anti-GAD Ab, and 35.6% were positive for IAAs. The prevalence of islet autoantibodies was significantly higher in the prepubertal groups than in the postpubertal groups (80.0% vs. 58.3%). The rate of positive islet autoantibodies changed with the duration of disease, and it differed according to the type of autoantibody and the age of the patient. Conclusion: The rates of positive islet autoantibodies were significantly higher in younger than in older patients at the time of the diagnosis of the disease. The positive rates were significantly changed 1 year after the onset of the disease in the preschool and the children groups. So these findings suggest that we need to diagnose type 1B diabetes distinguished T2DM in aldolescent group, carefully.

가변 순차 여파기를 이용한 직류 전동기의 속도 제어에 관한 연구

공영화,권우현 대한전자공학회 1983 전자공학회지 Vol.20 No.2

본 논문에서는 위상 고정 회로를 이용한 직류 전동기의 동기화 속도 제어 방법 중 가변 순차 여파기를 주파수 비교기로 사용한 제어 방식을 제안하고, 이를 실제로 구성하여 특성을 조사하였다. 가변 순차 여파기를 이용하므로써 제어계의 과도 응답 시간을 단순한 가역 계수기를 주파수 비교기로 이용한 계보다 15(%) 이상 개선시켰고, 정상 상태 속도 오차는 1회전상 0.05(%)이내로 줄일 수 있었다. In this paper, a method to control the speed of a dc motor using a phase locked loop circuit with a variable sequential filter is discussed. We improved the transient response time more than 15 percent compared to conventional system using a variable sequential filter and the steady state error was reduced to less than 0.05 percent per rotation axis.

Outcomes Associated with the Off-label Use of Medical Devices in Congenital Heart Disease at a Single Institute

공영화,송진영,허준,강일석 대한심장학회 2017 Korean Circulation Journal Vol.47 No.4

Background and Objectives: While the off-label use of implantable medical devices for treating congenital heart disease is not uncommon, the present conditions and outcomes of their off-label use have rarely been described. Therefore, this study evaluated the prevalence and results of using implantable devices off-label to treat congenital heart disease at a single institute. Subjects and Methods: This was a retrospective study based on the medical records of catheter-based interventions for congenital heart disease performed from July 1, 1995 to June 1, 2015. The inclusion criterion was the off-label use of an implantable device. Patient demographic data, procedural success, and follow-up status regarding late complications were investigated, and the results of the off-label use of each device were compared. Results: Off-label use occurred in 144 of 1730 interventions with device implantation, accounting for 8.3% of the interventions. The median patient age and mean body weight were 51.0 months and 16.3 kg, respectively. Immediate and late failures were found in 9 cases, and 3 cases of mortality were not directly related to the devices used. The overall success rate was 93.8%. There were no long-term complications of the off-label use of occlusion devices. No procedural failures resulted from stent implantation, but one case of stent malposition and two cases of stent fracture were identified after procedure completion. Conclusion: In general, the off-label use of implantable devices for treating congenital heart disease is safe and effective.

Multifocal Cerebral Infarction Associated with Patent Foramen Ovale in Fifteen-year-old Male : A Case Report

공영화(Young Hwa Kong),김선준(Sun Jun Kim) 대한소아신경학회 2013 대한소아신경학회지 Vol.21 No.3

건강한 젊은 환자에서 뇌경색은 흔히 발생하지 않는다. 소아청소년 환아에서 발생한 뇌경색에서 사망률은 낮으나 이 질병에 의해 지속적으로 신경학적 이상이 남게 된다. 이에 따라 최근에는 뇌경색 위험 인자를 찾아 미리 예방하고자 하는 노력들이 계속되고 있다. 그 중에서도 난원공 개존증은 뇌경색의 위험인자로 잘 알려져 있고, 특히 원인 불명 뇌경색에서 흔히 동반되고 있다. 왼측 편마비와 감각 이상을 제외한 진찰 소견에서는 특이 소견을 보이지 않는 15세 남자 환아가 내원하여 시행한 뇌 MRI와 spectros-copy에서 다발성의 뇌경색 소견을 보였으며 원인 평가를 위한 경식도 심초음파 검사에서 난원공 개존증을 진단받았다. 추후 난원공 개존증 폐쇄 시술을 받았으며 이후로 1년동안 추가적인 신경학적 이상 없었다. Infarction is an uncommon occurrence in healthy young patients. Despite the lower mortality rate of infarction in the pediatric patients, there is a high social impact of the disease. Recent years are represented by the increased attention that is placed on detecting risk factors of infarction. Patent foramen ovale (PFO) is attributable to the important risk factor that has been associated with cerebral infarction of unknown etiology or cryptogenic infarction. Since the treatment to prevent recurrence in infarction is percutaneous closure with permanently implanted closure devices. We present a case of fifteen-year-old male who admitted to hospital after he had paresthesia and hemiparesis. His physical, cardiologic and neurologic examinations were normal, except for the left hemiparesis and left finger paresthesia. On admission, magnetic resonance imaging and magnetic resonance imaging spectroscopy revealed multifocal hyperintense lesions consistent with acute ischemic events. Further evaluation with an aim to define the cause of infarction revealed a PFO with right-to-left shunt. He was underwent closure of the PFO using the Amplatzer occluder??. Since one year after procedure, the patient has been visiting the out-patient department without recurrence of neurologic or cardiologic events.

Fludrocortisone in Pediatric Vasovagal Syncope: A Retrospective, Single-Center Observational Study

이서연,공영화,김선준 대한신경과학회 2021 Journal of Clinical Neurology Vol.17 No.1

Background and Purpose The purpose of this study was to determine the effect of fludrocortisone in patients with pediatric vasovagal syncope (VVS). Methods This retrospective observational single-tertiary-center study based on chart reviews included 74 patients who were newly diagnosed with VVS in the head-up tilt-table test (HUTT). Some of the patients had been treated with fludrocortisone. All patients were assessed using a brain and cardiac workup before treatment to rule out the syncope being due to other causes, which resulted in seven of them being excluded: two for epilepsy and five for brain pathologies. The remaining 67 patients were analyzed. The effect of fludrocortisone was evaluated based on the results of a follow-up HUTT, with a response to the treatment considered to be present if there was a negative change at the follow-up HUTT. Univariate logistic regression were used for statistical analyses, with the criterion for significance being p<0.05. Results There were no significant differences in the characteristic of the patients between the no-medication (n=39) and fludrocortisone (n=28) groups, including age, sex, and duration of treatment. The recurrence rate of syncopal or presyncopal events was significantly lower in the fludrocortisone group (39.3%, 11 of 28) than in the no-medication group (64.1%, 25 of 39) (p=0.044), as was the rate of negative change at the follow-up HUTT: 57.1% (16 of 28) and 28.2% (11 of 39), respectively (p=0.017). Conclusions Our findings suggest that fludrocortisone is more effective than no medication in pediatric patients with VVS.

Left ventricular hypertrophy and diastolic function in children and adolescents with essential hypertension

이혜림,공영화,김경희,허준,강이석,송진영 대한고혈압학회 2015 Clinical Hypertension Vol.21 No.20

Introduction: Left ventricular hypertrophy and diastolic dysfunction in children and adolescents with essential hypertension tend to be underdiagnosed. The aims of this study were to investigate left ventricular hypertrophy and diastolic dysfunction in the subjects with essential hypertension defined by ambulatory blood pressure monitoring. Methods: A total of 38 Korean subjects aged 9–19 years without secondary causes of hypertension were reviewed. Ambulatory blood pressure monitoring was done in the 38 subjects to diagnose hypertension and gain the information of blood pressure pattern. The subjects were divided into two groups: a group with elevated blood pressure (BP) index (n = 29) and a group with normal BP index (n = 9). Two-dimensional ultrasound with M-mode imaging and tissue Doppler imaging were performed to measure left ventricular mass index and to assess the left ventricular diastolic dysfunction. Results: Left ventricular mass index(g/m2.7) was significantly higher in the group with elevated BP index than the group with normal BP index, but there were no differences in left ventricular diastolic dysfunction evaluated by E/A ratio and E/E’ ratio. Left ventricular mass index was related only with body mass index, while any of the ambulatory blood pressure monitoring parameters did not predict left ventricular hypertrophy. In terms of diastolic dysfunction in essential hypertension, E/E’ ratio in the subjects with left ventricular hypertrophy was higher than that in the other subjects without left ventricular hypertrophy. Discussion: Left ventricular mass index is significantly correlated with body mass index in children and adolescents with essential hypertension, and the diastolic dysfunction could be in higher risk in subjects with left ventricular hypertrophy.

Clinical Significance of Asymmetric Minimum Intensity Projection Images of Brain Magnetic Resonance Imaging in Children

김한솔,김선준,공영화 대한신경과학회 2019 Journal of Clinical Neurology Vol.15 No.3

Background and Purpose The susceptibility-weighted imaging form of brain MRI using minimum intensity projection (mIP) is useful for assessing traumatic brain injuries because it readily reveals deoxyhemoglobin or paramagnetic compounds. We investigated the efficacy of using this methodology in nontraumatic patients. Methods We retrospectively analyzed the asymmetric mIP findings in nontraumatic patients. Asymmetric mIP images were first verified visually and then using ImageJ software. We enrolled patients with a difference of >5% between hemispheres in ImageJ analysis. All patients underwent detailed history-taking and EEG, and asymmetric mIP findings were compared. Results The visual analysis identified 54 pediatric patients (37 males and 17 females) with asymmetric mIP findings. Ten patients were excluded because they did not meet the ImageJ verification criteria. The 44 patients with asymmetry comprised 36 with epilepsy, 6 with headache, and 2 with cerebral infarction. Thirty-one of the 36 epileptic patients showed definite partial seizure activities in semiology, while the remaining patients did not demonstrate a history of partial seizure manifestations. The MRI findings were normal in all patients except for five with periventricular leukomalacia unrelated to seizure symptoms. There was agreement between mIP images and semiology in 29 (93.5%) of the 31 epileptic patients with focal signs, while the other 2 demonstrated discordance. Twenty (64.5%) of the 31 patients showed consistent EEG abnormalities. Conclusions Our data suggest that asymmetric mIP findings are an excellent lateralizing indicator in pediatric patients with partial epilepsy.

Effects of low-dose topiramate on language function in children with migraine

한승아,양유진,공영화,주찬웅,김선준 대한소아청소년과학회 2017 Clinical and Experimental Pediatrics (CEP) Vol.60 No.7

Purpose: This study aimed to verify the safety of low-dose topiramate on language development in pediatric patients with migraine. Methods: Thirty newly diagnosed pediatric patients with migraine who needed topiramate were enrolled and assessed twice with standard language tests, including the Test of Language Problem Solving Abilities (TOPs), Receptive and Expressive Vocabulary Test, Urimal Test of Articulation and Phonology, and computerized speech laboratory analysis. Data were collected before treatment, and topiramate as monotherapy was sustained for at least 3 months. The mean follow-up period was 4.3± 2.7 months. The mean topiramate dosage was 0.9 mg/kg/day. Results: The patient’s mean age was 144.1±42.3 months (male-to-female ratio, 9:21). The values of all the language parameters of the TOPs were not changed significantly after the topiramate treatment as follows: Determine cause, from 15.0±4.4 to 15.4±4.8 (P>0.05); making inference, from 17.6±5.6 to 17.5±6.6 (P>0.05); predicting, from 11.5±4.5 to 12.3±4.0 (P>0.05); and total TOPs score, from 44.1± 13.4 to 45.3±13.6 (P>0.05). The total mean length of utterance in words during the test decreased from 44.1±13.4 to 45.3±13.6 (P<0.05). The Receptive and Expressive Vocabulary Test results decreased from 97.7±22.1 to 96.3±19.9 months, and from 81.8±23.4 to 82.3±25.4 months, respectively (P>0.05). In the articulation and phonology validation in both groups, speech pitch and energy were not significant, and all the vowel test results showed no other significant values. Conclusion: No significant difference was found in the language-speaking ability between the patients; however, the number of vocabularies used decreased. Therefore, topiramate should be used cautiously for children with migraine.

Clinical characteristics of hypertensive encephalopathy in pediatric patients

안창훈,한승아,공영화,김선준 대한소아청소년과학회 2017 Clinical and Experimental Pediatrics (CEP) Vol.60 No.8

Purpose: The aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children. Methods: We retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children’s Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non–renalorigin hypertension group according to the underlying cause. We compared the clinical features and brain MRI findings between the 2 groups. Results: The renal group included renal artery stenosis (4), acute poststreptococcal glomerulonephritis (2), lupus nephritis (2), and acute renal failure (1); the nonrenal group included essential hypertension (4), pheochromocytoma (2), thyrotoxicosis (1), and acute promyelocytic leukemia (1). The mean systolic blood pressure of the renal group (172.5±36.9 mmHg) was higher than that of the nonrenal group (137.1±11.1 mmHg, P<0.05). Seizure was the most common neurologic symptom, especially in the renal group (P<0.05). Posterior reversible encephalopathy syndrome (PRES), which is the most typical finding of hypertensive encephalopathy, was found predominantly in the renal group as compared with the nonrenal group (66.6% vs. 12.5%, P<0.05). Conclusion: We conclude that the patients with renal-origin hypertension had a more severe clinical course than those with non–renal-origin hypertension. Furthermore, the renal-origin group was highly associated with PRES on brain MRI.

Osteopetrosis Associated with Hydrocephalus and Rickets: A Case Report

황선미(Sun Mi Hwang),공영화(Young Hwa Kong),김선준(Sun Jun Kim) 대한소아신경학회 2014 대한소아신경학회지 Vol.22 No.3

Osteopetrosis or albers-Schonberg disease is extremely rare disease. It is characterized by osteoporosis, stunted growth, deformity, increased likelihood of fractures, also patients suffers anemia, recurrent infections and hepatosplenomegaly. However, we recently came upon a 14-month-old female as the 1st child of osteopetrosis with hydrocephalus and rickets. She has the typical symptoms such as nystagmus, osteosclerosis -especially in skull. Brain Magnetic Resonance Imaging (MRI), MRI shows hydrocephalus and x-ray finding are consistent with rickets. This is the first report of osteopetrosis with hydrocephalus and rickets in Korea by pediatrician.