Discordant findings of dimercaptosuccinic acid scintigraphy in children with multi-detector row computed tomography-proven acute pyelonephritis

이정민,권덕근,박세진,배기수 대한소아청소년과학회 2011 Clinical and Experimental Pediatrics (CEP) Vol.54 No.5

Purpose: The diagnosis of acute pyelonephritis (APN) is often difficult,as its clinical and biological manifestations are non-specific in children. If not treated quickly and adequately, however, APN may cause irreversible renal damage, possibly leading to hypertension and chronic renal failure. We were suspecting the diagnostic value of ^99mTc-dimercaptosuccinic acid (DMSA) scan by experiences and so compared the results of DMSA scan to those of multi-detector row computed tomography (MDCT). Methods: We retrospectively selected and analyzed 81 patients who were diagnosed as APN by MDCT during evaluation of their acute abdomen in emergency room and then received DMSA scan also for the diagnostic work-up of APN after admission. We evaluated the results of imaging studies and compared the diagnostic value of each method by age groups, <2 years (n=45) and ≥2 years (n=36). Results: Among total 81 patients with MDCT-proven APN, DMSA scan was diagnostic only in 55 children (68%), while the remaining 26 children (32%) showed false negative normal findings. These 26patients were predominantly male and most of them, 19 (73.1%) were <2 years of age. Conclusion: DMSA scan holds obvious limitation compared to MDCT in depicting acute inflammatory lesions of kidney in children with APN, especially in early childhood less than 2 years of age. MDCT showed hidden lesions of APN, those were undetectable through DMSA scan in children.

소아 급성 세균성 신엽염의 임상상 및 신장 예후

이동기,권덕근,임윤주,신윤혜,윤석남,배기수,Lee Dong-Ki,Kwon Duck-Geun,Lim Yun-Ju,Shin Yun-Hye,Yun Suk-Nam,Pai Ki-Soo 대한소아신장학회 2004 Childhood kidney diseases Vol.8 No.2

목적: 소아에서 드문 질병인 급성 세균성 신엽염의 질병 성격을 살피기 위하여, 9명의 환아를 대상으로 발현 증상, 임상 경과, 치료 반응, 동반 요로 기형, 신장 손상 정도 등을 조사하였다. 방법: 1994년 9월부터 2004년 8월까지 복부 초음파 또는 복부 컴퓨터 단층 촬영을 통하여 신엽염으로 확진된 9명의 환아를 대상으로 진료 기록을 후향적으로 분석하였다. 결과: 대상 환자들의 연령분포는 1개월에서 6세까지 평균 $2.8{\pm}2.2$세였으며, 성별로는 남자 6명 여자 3명이었다. 발열 및 오한은 모든 환자에서 있었고, 그 외 복통, 배뇨곤란 및 빈뇨가 있었다. 내원 당시 시행한 검사실 검사상, 백혈구수 $21,000{\pm}5,600/uL$, ESR $60{\pm}23mm/hr$, CRP $17{\pm}10\;mg/dl$이었으며. 혈액 배양 검사는 모두 음성이었다. 소변 검사상, 농뇨 및 현미경적 혈뇨는 모든 환자에게 있었고, 치료후 농뇨가 소실되기까지 $10.5{\pm}7.8$일이 소요되었다. 복부 초음파 검사상, 신장에 국소적으로 경계가 불명확하면서 에코가 떨어져 있는 신엽염 소견이 5명(55.5%)에서 관찰되었다. 복부 컴퓨터 단층 촬영에서는 불명확한 경계를 띠고 조영제에 증강이 잘 되지 않는 쐐기 모양의 신엽염의 소견이 모든 환자에서 관찰되었다. 방광요관역류는 3명(33.3%)에서 있었으며, 모두 3단계 이상이었다. $^{99m}Tc-DMSA$ 스캔에서는 일측 또는 양측 신장의 피질 손상이 확인되었다. 4개월 후 추적한 스캔상, 6명중 2명(33%)은 이전에 비해 병변의 크기가 감소되었으나, 나머지 4명(67%)은 병변의 크기가 불변 또는 약간 악화된 소견이었다 환아의 총 발열기간은 $11.8{\pm}6.3$일로, 이중 입원전 기간은 $4.0{\pm}3.0$일, 입원후 기간은 $7.8{\pm}5.5$일이었다. 입원 기간은 7일에서 31일까지 평균 $17.2{\pm}8.1$일이었다. 결론: 요로감염 환아에서 치료 후에도 1주이상 발열, 농뇨, 높은 혈액 염증 수치가 지속될 경우 '급성 세균성 신엽염'을 적극 의심하여야 하며, 질환의 정확한 진단을 위하여 신장 초음파검사 보다는 컴퓨터 단층 촬영을 우선 실시할 것을 제안하는 바이다. Purpose: This study was perfonned to elucidate the clinical pictures of acute focal bacterial nephritis(nephronia) in children. Methods: We reviewed 9 children with nephronia diagnosed by ultrasonography or computed tomography of kidneys from September 1994 to August 2004. Results: The overall male to female ratio was 2:1, and the age distribution ranged from 0.1 to 6 years(mean $2.8{\pm}2.2$). The cardinal symptoms were fever, chills, abdominal pain and dysuria/frequency. The initial leukocyte count was $21,000{\pm}5,600/uL$, ESR $60{\pm}23mm/hr$, CRP $17{\pm}10\;mg/dl$. Pyuria was noted in every patient and persisted for $10.5{\pm}7.8$ days after antimicrobial treatment. Abdominal sonography demonstrated focal lesion of ill-defined margin and low echogenicity in 5 of 9 patients(55.6%), while computed tomography revealed nonenhancing low density area in all patients(100%). Three of 9 patients(33.3%) had vesicoureteral reflux, greater than grade III. The initial $^{99m}Tc-DMSA$ scan showed one or multiple cortical defects in every patient, and improvements were noted in 2(33.3%) of 6 patients who received follow up scan after 4 months. Intravenous antibiotics was given in every patient under admission. Total febrile period was $11.8{\pm}6.3$ days(pre-admission, $4.0{\pm}3.0;$ post-admission, $7.8{\pm}5.5$ days) and the patients needed hospitalization for $17.2{\pm}8.1$ days. Conclusion: For the early diagnosis of 'acute focal bacterial nephritis' we should perform renal computed tomography first rather than ultrasonography, when the child has toxic symptoms and severe inflammatory responses in blood and urine.

Silicon carbide 복합재료의 제조

이명천,권덕근,김홍범 ( Myung Cheon Lee,Duk Geun Kweon,Hong Bum Kim ) 한국화학공학회 1996 화학공학의이론과응용 Vol.2 No.1

급성신우신염 환아에서 DMSA 스캔상 발견된 신결손의 예후 인자

서영선,권덕근,신윤혜,배기수,Seon, Yeong-Seon,Kwon, Duck-Geun,Shin, Yun-Hyea,Pai, Ki-Soo 대한소아신장학회 2010 Childhood kidney diseases Vol.14 No.2

목 적 : 요로감염 환아에서 영구적 신장손상을 예측하기 위하여, 연령, 발열기간 및 농뇨 지속기간, 방광요관역류나 수신증 여부 등을 비교, 분석하였다. 방 법 : 2000년 1월부터 2005년 1월까지 아주대학교 병원에서 요로감염으로 입원한 환아 중 DMSA에서 신장 결손을 보인 160명의 환아를 대상으로 6개월 후 추적 DMSA에서 회복된 회복군과 반흔이 남은 반흔군으로 나누어 각각의 특징을 비교분석하였다. 결 과 : 전체 대상 환아 160명 중 106명이 추적 DMSA에서 회복을 보였고, 54명이 반흔이 남아 33.8%의 발생률을 보였다. 반흔군에서 처음 진단 당시의 나이가1세 이상인 환자가 회복군에 비해 많았고(P=0.01), 발열기간, 농뇨지속 기간 등이 회복군에 비해 길었으며, 발열의 기왕력이 있었다. VCUG, Ultra-sound sonography에서도 반흔군이 회복군에 비해 비정상적 결과를 보인 경우가 많았다. 결 론 : 급성신우신염을 앓은 소아에서 감염당시 환아의 나이가 많을수록, 발열 기간이나 농뇨 지속 기간이 오래 될수록, 방광요관역류나 초음파검사 이상소견이 있는 초기 신결손이 신반흔으로 고착되는 경향을 확인할 수 있었다. 특히 잦은 발열 기왕력이 있는 경우 신손상 발생률이 높은 것을 볼 때, 이는 임상에서 미처 진단되지 못한, 혹은 잘 못 진단된 급성신우신염이 있음을 시사해 준다. Purpose : The purpose of this study is to determine if there are prognostic factors leading to permanent parenchymal damages to kidney in children after acute pyelonephritis. Methods : This study was conducted in 160 pediatric patients with acute pyelonephritis admitted to Ajou University Hospital from 2000 to 2005, whose renal cortical defects were confirmed by $^{99m}Tc$-dimercaptosuccinic acid scintigraphy (DMSA scan). Along with the follow-up DMSA scan after 6 months, they were classified into two groups; recovered group (106) and scarred group (54). The clinical characteristics of each group were compared. Results : Among the total of 160 patients, 106 (66.3%) showed recovery of the initial defect (the recovered group), while 54 (33.8%) showed permanent defects on the followup DMSA scan (scarred group). Recovery rate was poor for patients of 1 year and older, or patients with the duration of fever and pyuria longer than 7 days. The recovery rate was poor in the patients with history of frequent febrile episodes and abnormal results of imaging studies, such as voiding cystourethrography (VCUG), ultrasonography. Conclusion : The recovery rate of children with renal defects on DMSA scan with acute pyelonephritis was lower when the patient is older than 1 year, when the duration of fever and pyuria exceeded 7 days, and when the patients had the histories of frequent febrile episodes and had urinary tract abnormalities on imaging studies. These findings suggest that there may be under- or mis-diagnosis of acute pyelonephritis by pediatrician.

일반연제 발표 : 메산지움 IgA 침착 질환에서 사이클로스포린A의 항단백뇨 효과

정우철,안미선,권덕근,신윤혜,배기수 대한신장학회 2006 춘계학술대회 초록집 Vol.25 No.1

Silicon Carbide 복합재료의 기지재료용 Polycarbosilane 전구체의 합성

강석민,이명천,권덕근,김홍범 ( Suk Min Kang,Myung Cheon Lee,Duk Geun Kweon,Hong Bum Kim ) 한국화학공학회 1995 화학공학의이론과응용 Vol.1 No.2

4세 미만 소아에서 호두 알레르기의 임상 특성과 땅콩과의 교차 반응성 연구

이정민,김은진,권덕근,이수영 대한 소아알레르기 호흡기학회 2011 Allergy Asthma & Respiratory Disease Vol.21 No.4

Purpose:Walnut (WN) allergy in young children has rarely been reported in Asia. This study focused on the clinical characteristics of WN allergy, co-sensitization, and cross-reactivity between WN and peanut (PN) in young Korean children. Methods:This study was based on a data analysis of 22 patients, all under the age of 4 years, who were diagnosed with allergic disease at Ajou University Hospital from January 2009 to December 2010. They were suspected to have a WN allergy or needed a screening examination to exclude food allergy. Sera from all children were analyzed for PN-, WN-, and pine nut-specific immunoglobulin E (IgE) (ImmunoCAP). Clinical details, feeding, and familial history of patients were collected by medical history. Additionally, we produced WN, PN, and pine nut extracts, and sera were tested with an enzyme linked immunosorbentassay inhibition test. Results:The subjects were 16 male and 6 female with a median aged of 24 months. Ten of 22 had a definite history of WN exposure. Among them, two (4.28 kU/L, 11.1 kU/L) were diagnosed with anaphylaxis, four (7.34 to 27.4 kU/L) were diagnosed with angioedema, and four (1.35 to 3.17 kU/L) were diagnosed with urticaria. We confirmed that PN in the IgE-ELISA was profoundly inhibited by the WN extract. Conclusion:This study identified multiple cases of WN allergy in young children in Korea, indicating that it is not rare. Co-sensitization and clinical adverse reactions between PN and WN suggests that more investigations are needed to conclude cross-reactivity between PN and WN.

야뇨증 치료반응 예측에 관계하는 평가지표

이강균,이현정,임윤주,권덕근,김은진,배기수,Lee, Kang-Gyoon,Lee, Hyun-Jung,Lim, Yun-Ju,Kwon, Duck-Geun,Kim, Eun-Jin,Pai, Ki-Soo 대한소아신장학회 2007 Childhood kidney diseases Vol.11 No.2

목 적 : 야뇨증 환자를 진료할 때 병인을 밝히고자 시행하는 문진, 야뇨기록, 배뇨기록, 각종 체액 화학검사, 영상검사 및 초기 평가기간 동안의 행동치료요법의 효과 등의 요소가 환자의 치료반응에 미치는 영향을 밝히고자 하였다. 방 법 : 2003년 1월부터 2007년 5월까지 야뇨증으로 아주대병원 소아과를 방문한 환아 159명을 대상으로 이들의 나이, 성별, 체중, 키, 최소배뇨용적, 최대배뇨용적, 배뇨횟수, 취침전후 요비중 변화 등을 측정하였으며, 치료 전 평가기간 2주째, 치료개시 후 2개월 시점의 야뇨증 호전 빈도를 측정하였다. 치료효과는 야뇨횟수가 90% 이상 감소될 경우를 완전반응, 50% 이상 90% 미만 감소된 경우를 부분반응, 50% 미만으로 감소된 경우를 무반응으로 구분하였다 또한 치료개시 이전 2주간의 평가기간 동안 야뇨증 횟수가 줄어든 환자들을 초기반응군 이라 칭하고, 그렇지 않은 초기불응군과 비교분석을 실시하였다. 결 과: 대상 환아는 총 159명이었으며 남자 74명(46.5%), 여자 85(53.5%)이었다. 연령분포는 5-6세 96명, 7-8세 38명, 9-14세 25명이었다. 일차성 야뇨증이 132명(83%)이었으며, 이차성이 27명(17%)이었다. 최소배뇨용적은 $40.9{\pm}31.0 mL$, 최대배뇨용적은 $156.7{\pm}69.2 mL$이었으며, 최대방광용적의 비는 $0.59{\pm}0.21$, 평균배뇨횟수는 하루 $6.7{\pm}2.2$회였다. 취침 전 소변의 비중을 취침 후와 비교하였을 때, 아침 소변의 비중이 감소된 요희석군은 59명(40.4%), 비중이 증가된 요농축군은 87명(59.5%)이었다. 2개월째 치료효과를 분석하였을 때, 요희석군은 무반응 7명(5.8%), 부분반응 23명(22.3%), 완전반응 9명(8.7%)으로 요농축군의 무반응 9명(8.7%), 부분반응 41명(39.8%), 완전반응 14명(13.6%)에 비하여 치료효과가 낮은 경향을 보였으나 통계적으로 유의하지는 않았다(P>0.05). 35명의 경우, 치료 2개월째 무반응 2명(5.7%), 부분반응 19명(54.3%), 완전반응 14명(40.0%)으로, 초기불응군 74명의 무반응 18명(24.3%), 부분반응 46명(62.2%), 완전반응 10명(13.5%)에 비해 치료효과가 높았다(P<0.05). 결 론 : 야뇨증환아에서 병원방문 이후 행동요법만으로 야뇨횟수에 호전을 보이는 초기반응군 경우 2개월째 투약반응이 유의하게 좋았다. 이로써 야뇨증의 치료초기 행동요법에 대한 반응정도는 치료효과를 예측하는 지표로서 활용될 수 있다고 판단된다. Purpose : We tried to find out the clinical parameters which predict the outcome of treatment in children with enuresis. Methods : Enuresis patients who visited our hospital during 2003-2007 were included. Parameters such as age, gender, height, weight, minimal voided volume, maximal voided volume, maximum functional bladder capacity, frequency of voiding, urine S,G. before and after sleep were measured and an enuresis diary was also recorded. The reduction in wetting frequencies were classified into three groups; none(<50%), partial(50-90%) and complete(90%) response groups. We also compared the 'initial responders' who showed improvement(${\ge}50%$) during the 2 weeks of evaluation and behavioral therapy to the 'initial non-responders'. Results : Parameters mentioned above showed no significant relation to the treatment out-come. The response rate during the 2 weeks of the evaluation period was 32%(49/151) [complete in 1.3% (2/151), partial in 29.6% (47/151)]. Two-months' treatment responses were complete in 14(40%), partial in 19(54.3%) and none in 2(5.9%) responders(n=35), while they were 10(13.5%), 46(62.2%) and 18(24.3%), respectively in the non-responders(n=73) (P<0.05). Conclusion : We suggest that initial 'responsiveness' can be used as a predictor for good treatment outcome in patients with enuresis.

4세 미만 소아에서 호두 알레르기의 임상 특성과 땅콩과의 교차 반응성 연구

이정민 ( Jeong Min Lee ),김은진 ( Eun Jin Kim ),권덕근 ( Duck Guen Kwon ),이수영 ( Soo Young Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2011 소아알레르기 및 호흡기학회지 Vol.21 No.4

Purpose: Walnut (WN) allergy in young children has rarely been reported in Asia. This study focused on the clinical characteristics of WN allergy, co-sensitization, and cross-reactivity between WN and peanut (PN) in young Korean children. Methods: This study was based on a data analysis of 22 patients, all under the age of 4 years, who were diagnosed with allergic disease at Ajou University Hospital from January 2009 to December 2010. They were suspected to have a WN allergy or needed a screening examination to exclude food allergy. Sera from all children were analyzed for PN-, WN-, and pine nut-specific immunoglobulin E (IgE) (ImmunoCAP). Clinical details, feeding, and familial history of patients were collected by medical history. Additionally, we produced WN, PN, and pine nut extracts, and sera were tested with an enzyme linked immunosorbentassay inhibition test. Results: The subjects were 16 male and 6 female with a median aged of 24 months. Ten of 22 had a definite history of WN exposure. Among them, two (4.28 kU/L, 11.1 kU/L) were diagnosed with anaphylaxis, four (7.34 to 27.4 kU/L) were diagnosed with angioedema, and four (1.35 to 3.17 kU/L) were diagnosed with urticaria. We confirmed that PN in the IgE-ELISA was profoundly inhibited by the WN extract. Conclusion: This study identified multiple cases of WN allergy in young children in Korea, indicating that it is not rare. Co-sensitization and clinical adverse reactions between PN and WN suggests that more investigations are needed to conclude cross-reactivity between PN and WN. (Pediatr Allergy Respir Dis(Korea) 2011;21:261-268)