소아 신증후군에서의 혈전증

구자욱,박혜원,최용,정해일,하일수,하태선 대한신장학회 1993 Kidney Research and Clinical Practice Vol.12 No.4

We reviewed 10 nephrotic children with thromboembolic complications who were admitted to the Department of Pediatrics, Seoul National University Childrens' Hospital between May 1984 and march 1993 and the following results were obtained. 1) The patterns of thrombosis were pulmonary throm- boebolism (4 cases including 1 pulmonary artery thrombosis), cerebral infarction (2 cases), renal vein throm- bosis (2 cases), femoral artery thrombosis (1 case), radial artery thrombosis (1 case), and femoral vein with deep vein thrombosis (1 case). Among these cases, the radial artery throbmosis was accompanied with pulmonary thromboembolism. 2) The possible factors associated with thrombosis were as follows: iatrogenic factors (accidental femoral puncture and radial artery cannulation), steroid, diuretic therapy, hypovolvemic episode, sepsis and stasis. 3) Patients with only pulmonary thromboembolism or renal vein thrombosis improved considerably under the conservative treatment with systemic heparinization and anticoagulants. One patient with femoral artery thrombosis recovered completely with emergency thrombectomy, systemic heparinization and anticoagulant. Two patients were expired with massive pulmonary artery thrombosis and radial artery thrombosis. Unexplained pulmonary symptoms, decreased breathing sound and pneumonic infiltration on the chest X-ray during relapsing nephrotic syndrome should prompt further investigations to rule out Femoral artery punctures, or arterial cannulation of the extremities in patients with the nephrotic syndrome should be avoided.

Yersinia pseudotuberculosis 감염증과 급성 신부전증

구자욱 주식회사 녹십자 2004 녹십자의보 Vol.32 No.3

Yersinia pseudotuberculosis에 의한 급성 신부전증

구자욱,박혜원,정철영,조종래,최용,정해일 대한신장학회 1996 Kidney Research and Clinical Practice Vol.15 No.3

YP can cause a wide range of clinical problems such as mesenteric lymphadenitis, erythema nodo- sum, reactive arthritis, and sepsis. We have experienced 70 cases of YP infection in children diagnosed by stool culture (46 cases) and/or serology (24 cases) since 1987, A history of drinking or contact with untreated well or mountain water was detected in 67 cases. YP was also isolated from 5 samples of mountain spring water which was thought to be the sources of infection. The most prevalent serotypes were 5b(37/70) and 4b(24/70). During the course of illness, ARF developed in 18 cases(25.796). Additionally, serogroups for those from the water samples were 5 in 4 cases. The disease began with sudden onset of fever, rash, abdominal pain sometimes mimicking acute appendicitis. Periungual desquamaton, which was prominent in the ARF group, developed later in the course. Thrombocytosis and hypoalbuminemia were noticieable, and mild degrees of proteinuria, microscopic hematuria, and sterile pyuria were common in the ARF group. ARF developed between the 2nd and 17th days(mean 8.9 days) after the onset of fever, and oliguria ($lt;400ml/ m²/day) developed in 12 patients(12/18) immediately after their fevers had subsided. ARF underwent a benign course of complete recovery within 4 weeks at most(mean 10.2 days), with two exceptional cases requiring hemodialysis. Kgh FeNa, glucouria, decreased tubular reabsorption of phosphate($lt;85%) and increased urinary 52 microglobulin excretion, were suggesting proximal tubular damage. Renal biopsy showed evidence of tubulointerstitial nephritis. YP should be included as one of the causes of acute interstitial nephritis causing ARF in children, especially when the children have histories of drinking untreated water in endemic areas.

Waveguide attachment influences on acoustic emission evaluation for marginal disintegration of dental composite restorations

구자욱,박정훈,Seung-Wook Han,최낙삼 대한기계학회 2013 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.27 No.12

Influence of the waveguide attenuation was investigated on acoustic emission (AE) estimation for the marginal disintegration states of dental composite restorations. For the AE measurement, a human molar tooth substrate with an artificial class 1 cavity was made. A bonding agent was applied and a composite resin was tightly packed in the hole of the substrate. Under the light exposure to the composite resin the polymerization shrinkage occurred and the marginal failure generated AE waves. It was ascertained that the waveguide attachment brought about a great decrease in AE hits and amplitudes. Compensation for the attenuation loss of the AE parameters could offer some equivalency to the AE measurements by the direct attachment of the sensor on the substrate.

제주 전기자동차 실증 사업 데이터를 이용한 충전 인프라 최적화

구자욱,이종호,이주연 한국경영과학회 2016 한국경영과학회 학술대회논문집 Vol.2016 No.4

Goldenhar 증후군 환자의 마취경험

구자욱,김천숙,강규식,정성학,유지현 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.2

Goldenhar syndrome is a rare congenital disorder of hemicraniofacial and vertebral defects related to the abnormal development of the first and second branchial arches. In some infants, congenital heart disease, and pulmonary and renal defects are also present. Goldenhar syndrome commonly involves an airway which is difficult to manage. Tracheal intubation may be difficult due to a combination of retrognathia, micrognathia, mandibular hypoplasia, palatal defects and vertebral abnormities. We experienced the anesthetic management of an 8-month-old boy with Goldenhar syndrome who received excision and biopsy for conjunctival dermoid and ureteral reimplantation for vesicoureteral reflux under general anesthesia. Airway management, with thiopental, rocuronium and sevoflurane, and tracheal intubation were accomplished successfully in the patient. Surgery was performed uneventfully and the patient was discharged without complication. (Korean J Anesthesiol 2006; 50: 209~12)

Renal Interstitial Fibrosis와 Renin Angiotensin System Inhibition

구자욱 대한소아청소년과학회 2001 Clinical and Experimental Pediatrics (CEP) Vol.44 No.3

소아기 혈뇨

구자욱 대한소아청소년과학회 2004 Clinical and Experimental Pediatrics (CEP) Vol.47 No.12

The detection of even microscopic amounts of blood in a child's urine, whether accompanied by symptoms or asymptomatic, alarms the patient, parents, and physician, and often prompts the performance of many laboratory studies. Hematuria is one of the most important signs of renal or bladder disease, but proteinuria is a more important diagnostic and prognostic finding, except in the case of calculi or malignancies. Hematuria is almost never a cause of anemia. Primary care physicians frequently encounter children with hematuria. Among children presenting to a pediatric emergency clinic, gross hematuria was found an incidence of 1.3 per 1000. Microscopic hematuria in children is much more common, with a prevalence rate between 1 and 4%. The pediatricians should ensure that serious conditions are not overlooked, while avoiding the performance of unnecessary and often expensive laboratory studies, and provide guidelines for additional studies if there is a change in the child's course. This article provides a stepwise approach to the evaluation and management of hematuria in a child. 혈뇨를 보이는 환아는 면밀한 병력, 가족력 및 이학적 소견에 대한 검사가 필요하다. 모든 환아가 일률적으로 같은 검사를 할 필요는 없다. 우선 적색뇨는 먼저 가성혈뇨 인지 진성 혈뇨인지를 감별한다. 혈뇨는 많은 조건들과 동반되어 나타날 수 있고, 일시적 현상일 수도 있으며 반면 심한 질환의 첫 소견일 수도 있다. 따라서 2-3주 이상의 시기 동안 세 번 정도의 요검사를 반복해야 하며, 혈뇨가Hematuria ↓ Dipstick test for blood (-) → Metabolites, Drugs ↓ (+) Microscopic examination for RBCs (-) → Hemoglobinuria, Myoglobinuria ↓ (+) History and Physical examination(Table 2), Family history(Table 5) ↓ RBC morphology of urine 1)Eumorphic RBCs(+), RBC casts(-):Non-glomerular hematuria ① CBC, BUN, S-Cr, Urine culture, U-Ca/Cr ratio, Urinalysis of family members, Renal ultrasound ② IVP, VCUG ③ Cystoscopy, Renal angiography 2)Dysmorphic RBCs(+), RBC casts(+), Proteinuria(+):Glomerular hematuria ①CBC, Electrolyte, Protein, Albumin, Cholesterol, BUN, S-Cr, C3, C4, ASO, anti-DNAse B, Hepatitis B serology, Renal ultrasound, 24 hour urine examination for GFR and protein excretion ②ANA, ANCA, Audiogram ③Renal biopsy Fig.4.Stepwise approach of a child with hematuria. CBC:complete blood cell count, IVP:Intravenous pyelography, VCUG:Voiding cystourethrogram, GFR:glomerular filtration rate, ANA:antinuclear antibody, ANCA:antineutrophil cytoplasmic antibody. 확실할 경우에는 혈뇨의 부위가 신성인지 신외성인지를 판정하고, 원인질환을 알아내기 위한 단계적인 평가가 있어야 한다(Fig. 3). 일반적으로 무증상의 현미경적 혈뇨의 경우 2년 이상 관찰 동안 특이한 소견 없으면 만성 신부전이나 기타 만성 신염으로 이행될 가능성은 적다. 그러나 보고자에 따라서는 현미경적 혈뇨 환자의 10-50%가 만성 신질환으로 이행될 위험성이 있다고 한다. 또한 이 경우 어느 기간 동안 추적 검사를 하는 것이 좋을 것인지에 대한 연구는 아직 없다. 한 연구에 따르면 현미경적 혈뇨의 2-5년 추적 검사를 한 장기적 예후는 초기의 지속적인 혈뇨, 단백뇨 유무 및 고혈압의 동반 여부에 따라 좌우된다고 한다. 따라서 현미경적 혈뇨의 경우에도 장기간 단백뇨, 고혈압 발생 등을 관찰하면서 추적 조사를 하면서 변화되는 환자의 문제를 유심히 살펴보아야 할 것으로 여겨진다.

제주 전기자동차 실증 사업 데이터를 이용한 충전 인프라 최적화

구자욱,이종호,이주연 대한산업공학회 2016 대한산업공학회 춘계학술대회논문집 Vol.2016 No.4

소아 CAPD에서의 복막염

구자욱,고광욱,최용,정해일,임인석,하일수,하태선 대한신장학회 1991 Kidney Research and Clinical Practice Vol.10 No.3

A retrospective analysis of peritonitis experiments in 24 ESRD patients with a mean age of 8.6 years, who underwent CAPD at the Pediatric Department of Seoul national University Hospital from Feb. 1987 to Aug. 1990, were performed. And the results were as follows: 1) A total of 54 episodes of peritonitis occurred during 7,696 patient-days of CAPD in 20 of the 24 patients with the incidence of peritonitis at 2.6 patient-year (1 per 4.8 patient-month). The incidence of peritonitis has declined progressively during past 4 years except 1989: 4.0 episodes per patient-year in 1987, 2.6 in 1988, 3.0 in 1989, and 1.4 in 1990. 2) The first episode of peritonitis was occurred within one week of beginning CAPD in 15% within 4 weeks in 45%, within 6 months in 809. And within 1 years in 100% of those who experienced peritonitis. 3) The rate of positive and negative culture were 59. 8%. (32/54) and 37.0% (20/54), respectively. Gram positive organisms were cultured in 56.3% (18/32), gram negative organisms in 21.8%. (7/32), CNS (28.1%, 9/32) and S.aureus (21.9%., 7/32) were most prevalent organisms. 4) Peritonitis were responsible for 20.9 days of hospitalization per patient-year. Peritonitis was successfully treated in outpatient basis only 33.3% and by antibiotics only in 85.2%. The remaining 8 (14%.) patients needed to remove the catheters for the treatment. 5) A total of 14 episodes (44% of all catheters) of pericathet er infection (including exit-site and tunnel infection) occurred during same period. In 57.2% (8/14) of these infections peritonitis followed. 6) Peritoneal catheters had to be removed in 17 episodes excluding of 5 episodes due to death and renal transplantation: in 8 episodes because of peritonitis. 7) A total of 32 peritoneal catheters were implanted. Mean surviaval of all catheters was 9.2 months. The actuarial catheter survival by Kaplan-Meier method was 58.6 % and 35.4% at 6 and 12 months, respectively. In conclusion, the future of CAPD as a long term therapeutic modality depends on peritonits. Therefore, new approaches to the prevention and the treatment CAPD peritonitis should be evaluated. If infection can be successfully managed and prevented, CAPD promised to become increasingly popular for treatment of end stage renal disease.