Prevention of Recurrent FSGS with Cyclosporine and Plasmapheresis Prior to Renal Transplantation

양은애,박효민,조민현,고철우,김형기,허승,Yang, Eun-Ae,Park, Hyo-Min,Cho, Min-Hyun,Ko, Cheol-Woo,Kim, Hyung-Kee,Huh, Seung Korean Society of Pediatric Nephrology 2010 Childhood kidney diseases Vol.14 No.1

국소 분절성 사구체 경화증은 소아 말기 신부전의 중요한 원인이며, 신이식 후에도 재발되는 특징을 보이는데, 이러한 재발에 대한 치료로는 혈장교환술과 사이클로스포린과 같은 면역억제제의 투여 등이 있다. 이에 저자들은 신이식 전 혈장교환술과 예방적 사이클로스포린을 투여하여 국소 분절성 사구체 경화증의 재발을 효과적으로 예방한 경험 2례를 보고하는 바이다. We report on two children with a high risk of recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation that could be effectively prevented by prophylactic administration of cyclosporine combined with preemptive plasmapheresis prior to renal transplantation.

소아 대엽성 폐렴에서 마이코플라즈마 폐렴의 임상적 특성

양은애 ( Eun Ae Yang ),강미현 ( Mi Hyeon Gang ),유선영 ( Sun Young You ),김진환 ( Jin Hwan Kim ),이재호 ( Jae Ho Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.3

Purpose: This study was conducted to evaluate the prevalence, clinical characteristics and laboratory findings of lobar pneumonia in children caused by Mycoplasma pneumonia and to find a diagnostic tool for identifying M. pneumoniae infection in children. Methods : We analyzed medical records of 78 children between March 2010 and December 2011, who were admitted to our hospital and diagnosed with lobar pneumonia on the basis of chest X-rays. White blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), specific antibodies to M. pneuomoniae, and cold agglutinin (CA) were measured at the time of admission. Children were divided into 2 groups: those with M. pneumoniae infection (group A) and those without infection (group B). Group A children were also subdivided into 2 categories: those with increased CA (group 1) and those without (group 2). Results: The prevalence of lobar pneumonia was higher in the year 2011 than in 2010. M. pneumonia infection usually occurs in summer and autumn. Group A children accounted for 75.6% (59/78) of all the cases. The onset ages was higher in group A than in group B (P =0.016). WBC counts and PCT values were higher in group B than in group A.(P =0.015 and P =0.011, respectively) Radiologic findings showed that the lower lobe was most commonly involved without predilection for either side and pleural effusion was present in 13.6% of all the cases. The duration of fever before admission was longer in group 1 than in group 2.(P =0.019) Conclusion : It is concluded that lobar pneumonia caused by M. pneumoniae can be more accurately diagnosed using serum PCT values than using CRP values.

Methylprednisolone 충격요법을 시행한 국소성 분절성 사구체 경화증 환아들의 임상경과

양은애 ( Eun Ae Yang ),박효정 ( Hyo Jung Park ),조민현 ( Min Hyun Cho ),고철우 ( Cheol Woo Ko ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.1

Purpose: The clinical characteristics and pathological findings of patients with focal segmental glomerulosclerosis (FSGS) receiving methylprednisolone pulse therapy (MP pulse therapy) according to the Mendoza protocol were studied to evaluate its therapeutic efficacy. Methods: The clinical course and pathological findings of 12 patients that were diagnosed with FSGS and treated according to the Mendoza protocol from 2001 to 2006 were reviewed retrospectively. Results: Only three patients among the total twelve patients finished MP pulse therapy, who were diagnosed with minimal change nephrotic syndrome on the first renal biopsy and have preserved renal function at the recent follow-up. Among them, one patient (8%) achieved complete remission, but relapsed 28-months after the end of therapy, and one patient (8%) had a partial remission. Eight patients progressed to end-stage renal disease (ESRD) and four regressed during therapy. All eight patients that were diagnosed with FSGS, on the first renal biopsy, progressed to ESRD and required hemodialysis or kidney transplantation. The frequency of ESRD in this group was statistically significant. Conclusion: MP pulse therapy according to the Mendoza protocol showed low therapeutic efficacy; it appeared effective in only 17% and most of the patients (67%) progressed to ESRD. There may be close correlation between the severity of glomerular sclerosis at biopsy and ESRD. These results suggest that the indications for MP pulse therapy according to the Mendoza protocol in nephrotic patients with FSGS requires further clarification.

스크립트를 이용한 몸짓언어 중재가 중도·중복장애 학생의 의사소통기능에 미치는 효과

양은애(Yang Eun-ae),김희규(Kim Hee-gyu) 한국특수교육교과교육학회 2019 특수교육교과교육연구 Vol.12 No.2

본 연구는 스크립트를 이용한 몸짓언어 중재가 중도·중복장애 학생의 의사소통 기능에 미치는 효과를 알아보는 것을 목적으로 하였다. 본 연구의 대상은 충남 C시의 특수학교에 배치된 중도·중복장애 학생 1명을 대상으로 하였으며, 본 연구에서 사용한 연구 도구는 진단 평가 도구로 Communication Matrix(커뮤니케이션 매트릭스)를 사용하였고, 의사소통 기능을 지도하기 위한 중재도구로 보완·대체의사소통 도구의 몸짓언어와 스크립트를 사용하였다. 연구 결과 스크립트를 이용한 몸짓언어 중재는 중도・중복장애 학생의 의사소통 기능인 사물 요구하기와 행동 요구하기의 빈도를 증가시켰다. This study aimed to analyze effects body language intervention based on script activities for the student with severe and multiple disabilities. A student with severe and multiple disabilities participated in the study and body language Intervention was selected based on his needs, functional level, physical condition, and mobility. The result follows that the communication skill of the student with severe and multiple disabilities improved, communication behaviors were increased. and the effect is maintained.

비염을 가진 소아 및 청소년 환자에서 비호산구와 흡입항원 감작의 상관성

양은애 ( Eun Ae Yang ),박유미 ( Yu Mi Park ),김경훈 ( Kyung Hoon Kim ),이혜진 ( Hye Jin Lee ),김환수 ( Hwan Soo Kim ),전윤홍 ( Yoon Hong Chun ),윤종서 ( Jong-seo Yoon ),김현희 ( Hyun Hee Kim ),김진택 ( Jin Tack Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.3

Purpose: To identify the correlation between nasal eosinophilia and aeroallergen sensitization in children and adolescents. Methods: This is a retrospective study of patients below 18 years of age who had a history of rhinitis that lasted more than 2 weeks or had been repeated more than once a year, received nasal eosinophil examinations, and had serum specific IgE to aeroallergens measured at an Allergy Clinic in a single tertiary teaching hospital in Seoul, Korea. The percentage of nasal eosinophils was calculated by the number of eosinophils per total leukocytes in a high-power field of 1,000×. Data was analyzed to determine the association between nasal eosinophilia and 18 aeroallergens. Results: Of the 245 patients included, 156 (63.7%) were male and the mean age (±standard deviation) was 7.9 years (±3.8). In total, 175 patients (71.4%) were sensitized to at least 1 of the 18 aeroallergens tested, and sensitization to house dust mite was most common. In addition, 118 (48.2%) and 69 patients (28.2%) had nasal eosinophilia of at least 1% and 5%, respectively. There were no significant correlations between serum total IgE or age and the percentage of nasal eosinophils. However, the percentage of nasal eosinophils in the group sensitized to any aeroallergens was significantly increased compared to the nonsensitized group (P=0.002). The percentage of nasal eosinophils was significantly higher in patients who were sensitized to Birch-Alder Mix, oak white, Bermuda grass, orchard grass, timothy grass, sweet vernal grass, rye, mugwort, short ragweed, Alternaria alternata, cats, dogs or Dermatophagoides farinae compared to those nonsensitized. Conclusion: Nasal eosinophilia was significantly associated with sensitization to aeroallergens. (Allergy Asthma Respir Dis 2018;6:161-167)

소아 및 청소년에서 24시간 활동 혈압 측정의 임상적 유용성

황영주,박효정,양은애,조민현,고철우,양동헌,황현희,Hwang, Young-Ju,Park, Hyo-Jung,Yang, Eun-Ae,Cho, Min-Hyun,Ko, Cheol-Woo,Yang, Dong-Heon,Hwang, Hyun-Hee 대한소아신장학회 2011 Childhood kidney diseases Vol.15 No.2

목적 : 소아 청소년에서 고혈압의 유병률이 증가하면서 혈압의 측정에 대한 관심이 증가하고 있다. 활동 혈압 감시는 진성 고혈압과 백의 고혈압의 진단에 유용하다고 알려져 있어 우리나라 소아 청소년을 대상으로 활동 혈압 감시의 임상적 유용성을 알아보기 위해 본 연구를 시행하였다. 방법: 2002년 1월부터 2010년 2월까지 경북대학교병원 소아청소년과 및 내과를 방문하여 활동 혈압 감시를 시행한 6세부터 18세까지의 소아 및 청소년 51명을 대상으로 하였다. 외래에서 측정한 수시 혈압과 활동 혈압 감시 결과로 계산된 평균 혈압, 혈압 부하 및 야간 하강 정도를 환자들의 임상적 특징과 진단 별로 비교하였다. 결과:전체 51명의 환자 중 남자가 49명이었으며 평균연령은 $17.8{\pm}1.8$세였고 19명(37.3%)이 비만이었다. 활동 혈압 감시 시행 중 평균 유효 측정횟수는 37.8회, 유효 측정률은 94.3%이었다. 활동 혈압 감시 결과 진성 고혈압 환자가 37명(72.5%)이 었고 이 중 1명이 가면 고혈압이었다. 7명(14%)은 백의 고혈압으로 진단되었으며 나머지 7명은 수시혈압과 24시간 활동 혈압 모두 정상이었다. 백의 고혈압으로 진단된 7명 중 5명이 고혈압 전 단계였다. 진성 고혈압 환자에서 평균 수축기와 이완기 혈압 부하는 정상 혈압 소아에 비해 유의하게 높았고(P<0.001) 야간 강하는 10% 이하였으나 통계적 유의성은 없었다. 비만 환자에서 평균 수축기, 이완기 혈압 및 혈압 부하가 유의하게 높았다(P<0.001). 결론 : 본 연구에서 소아 청소년에서 활동 혈압 감시가 진성 고혈압 및 백의 고혈압을 진단하는데 유용하였으며 백의 고혈압을 가진 소아의 상당수가 고혈압 전 단계에 해당되어 향후 이들에 대한 지속적인 추적 관찰이 필요한 것으로 생각된다. Purpose: With increasing prevalence of hypertension (HTN) in children and adolescent, pediatricians have become more interested in blood pressure (BP) measurements. The ambulatory blood pressure monitoring (ABPM) is known to be useful to differentiate true HTN and white coat HTN. The object of this study is to assess the clinical usefulness of ABPM in Korean children and adolescents. Methods: A retrospective review of 51 patients in Kyungpook National University Hospital from January 2002 to February 2010 was done. All patients were 6-18 years old and underwent ABPM. We calculated the mean value of ABP, BP load, nocturnal dip and compared the results with the patients' diagnosis and characteristics. Results: The mean age of the 51 patients was $17.8{\pm}1.8$ years and 19 children were obese. 37 patients (72.5%) were truly hypertensive and 1 patient was diagnosed as masked HTN and 7 children (14%) as white coat HTN. The rest of the patients were normotensive. Among patients with white coat HTN, 5 were in a prehypertensive state. Mean systolic and diastolic BP load of patients with true HTN were significantly higher than non-hypertensive children (P<0.001). Although the nocturnal dip of all patients were below 10%, there was no statistical significance. The obese patients showed higher systolic and diastolic BP. Their systolic and diastolic BP load were significantly higher than non-obese patients (P<0.001). Conclusion: ABPM in children and adolescents seems to be a valuable tool in the assessment of white coat HTN and in the confirmation of true HTN. A considerable number of white coat HTN patients are revealed to be in a prehypertensive state and need close follow-up.

급성 신우신염의 표지자로서 혈청 procalcitonin의 임상적 유용성

조민현 ( Min Hyun Cho ),양은애 ( Eun Ae Yang ),박준석 ( Jun Seok Park ),이상우 ( Sang Woo Lee ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6

Purpose: The clinical usefulness of serum procalcitonin (PCT) was evaluated for the diagnosis of acute pyelonephritis (APN) in infants with urinary tract infections (UTIs). Methods: A total of 46 infants (between 1 and 12 months of age) were enrolled in this study. Laboratory studies including the WBC count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and PCT were measured before initiation of intravenous antibiotic treatment and a 99mTc-DMSA renal scan was performed during treatment. Results: There were no significant differences in the mean age, gender and microorganisms detected between the patients with a lower UTI and those with APN. The duration of fever before and after treatment was significantly longer in the APN group. Except for the WBC count, there was a significantly higher ESR, serum CRP and PCT levels detected in the APN group. Although the serum CRP and PCT showed similar sensitivity and specificity for the diagnosis of APN, simultaneous measurement of the ESR, serum CRP and PCT increased the specificity and accuracy for the diagnosis of APN. Furthermore, only the serum PCT showed a statistically significant difference between the groups with no or only a very mild renal lesion (group 1) and the groups with significant renal lesions (group 2). Conclusion: The serum PCT combined with the ESR and serum CRP was a helpful marker for the diagnosis of APN. In addition, the serum PCT could be a useful predictor of the severity of renal parenchymal involvement associated with APN.

객담 배출이 어려운 소아청소년 결핵 의심 환자에서 굴곡성 기관지 내시경검사의 유용성

이혜진 ( Hye Jin Lee ),박유미 ( Yumi Park ),양은애 ( Eun Ae Yang ),김환수 ( Hwan Soo Kim ),전윤홍 ( Yoon Hong Chun ),윤종서 ( Jong-seo Yoon ),김현희 ( Hyun Hee Kim ),김진택 ( Jin Tack Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.5

Purpose: To assess the usefulness of flexible bronchoscopy in patients with suspected pulmonary tuberculosis (PTB) who have diffi-culty in sputum expectoration. Methods: The subjects of this study were patients who were suspected of PTB and visited the Division of Pediatric Pulmonology at a tertiary hospital from April 2006 to March 2016. PTB suspects were determined by clinical symptoms, radiologic findings, and im-munologic studies. We aimed to examine the value and safety of bronchoscopy in diagnosis and differential diagnosis of PTB in PTB- suspected patients. The diagnostic criteria for PTB were defined when Mycobacterium tuberculosis was cultured in the sputum speci-men or in the bronchial washing fluid. Results: A total of 19 PTB suspects were included. One patient was diagnosed with PTB by using the sputum study. However, the re-maining 18 patients could not expectorate sputum or showed no evidence of Mycobacterium tuberculosis infection from the spu-tum study. Of the 18 patients, 15 underwent bronchoscopy. After bronchoscopy, 6 patients were diagnosed with PTB and 9 patients were diagnosed with Mycoplasma, viral, or fungal pneumonia, and tumors. For antituberculous drug resistance, there were 1 case of isoniazid (INH) resistance and 1 case of concurrent resistance to INH and prothionamide. There was no multidrug-resistant tubercu-losis. None of the patients had significant complications due to bronchoscopy. Conclusion: Flexible bronchoscopy appears to be a definitive and safe procedure for the differential diagnosis of patients suspect-ing PTB in children who have difficulty expectorating sputum. (Allergy Asthma Respir Dis 2017;5:287-293)

소아 하기도 호흡기 감염에서 항생제 치료 가이드라인으로서의 혈청 procalcitonin의 임상적 유용성

임한혁 ( Han Hyuk Lim ),강혜진 ( Hye Jin Kang ),양은애 ( Eun Ae Yang ),이재호 ( Jae Ho Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.1

Purpose: Procalcitonin (PCT), a precursor of calcitonin, has been described as a biomarker of bacterial infection and inflammation. This study was performed to evaluate the clinical usefulness of PCT levels and to reduce the unnecessary usage of antibiotics in children with lower respiratory tract infection (RTI). Methods: Eighty-eight children, with lower RTI, under the age of 5 years, who were admitted to Chungnam National University Hospital, between May 2010 and December 2010, were enrolled. White blood cell counts, erythrocyte sedimentation rate, C-reactive protein, and PCT were measured. Blood and sputum cultures were performed to identify the causative bacteria and reverse transcription-polymerase chain reaction for the viruses. Clinical features were reviewed, retrospectively. Results: The mean participant age was 1.9±1.5 years. The cut-off value for serum PCT levels, which was derived from the receiver-operator characteristic curve, was 0.11·ng/mL. In 29 patients (33.0%) with low PCT levels (<0.11 ng/mL), antibiotic therapy showed no benefit for clinical and laboratory findings. However, in 59 patients (67.1%) with high PCT levels (≥0.11 ng/mL), hospitalization (P=0.005) and fever (P=0.054) exhibited a shorter duration, after antibiotic therapy. Conclusion: A single initial serum PCT levels (≥0.11 ng/mL) may be clinically useful to give a guideline for antibiotic treatment in children with lower respiratory tract infection and to reduce the unnecessary usage of antibiotics.

Polymerase chain reaction 양성 소아 마이코플라스마 폐렴에서 혈청 IgM enzyme-linked immunosorbent assays의 진단적 가치

이혜진 ( Hye Jin Lee ),이윤태 ( Yoon Tae Lee ),김경훈 ( Kyung Hoon Kim ),양은애 ( Eun Ae Yang ),김환수 ( Hwan Soo Kim ),전윤홍 ( Yoon Hong Chun ),윤종서 ( Jong-seo Yoon ),김현희 ( Hyun Hee Kim ),김진택 ( Jin Tack Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.5

Purpose: Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) in children. MP serum IgM and polymerase chain reaction (PCR) are the methods that enable early diagnosis in patients with MP pneumonia. The objective of this study was to investigate the clinical value of serum MP-specific IgM antibodies in PCR-positive MP pneumonia for the early diagnosis of MP pneumonia in children with CAP. Methods: Out of 129 patients with lower respiratory tract infection aged over 3 years, 90 CAP children were enrolled in the study. Throat swab MP real-time PCR and serum enzyme-linked immunosorbent assays (ELISA) IgM antibodies were performed. A positive rate of MP PCR and serum IgM, the level of IgM index, clinical features, and laboratory findings were analyzed. Results: MP PCR was positive in 57 cases. Longer fever duration before admission (P<0.001), higher rates of lobar or segmental pneumonia (P=0.048), unilateral infiltration (P=0.038), and extrapulmonary symptoms (P=0.049) were associated with MP PCR-positive pneumonia. Serum IgM index was significantly higher in MP PCR-positive pneumonia them in MP PCR-negative pneumonia (3.9±3.0 vs. 0.8±1.3, P<0.001). Using MP PCR as a gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of serum IgM were 85.5%, 82.1%, 91.4%, and 71.9%, respectively. The area under the curves for serum IgM index was 0.892, and the ROC analysis indicated that an optimal cutoff value of 1.05 for serum IgM provided the highest sensitivity and specificity interestingly (83.9% vs. 85.7%, P<0.001). Conclusion: Serum IgM ELISA has useful diagnostic value in PCR-positive MP pneumonia. Applying an IgM index cutoff of 1.05 improves diagnostic accuracy. (Allergy Asthma Respir Dis 2018;6:248-254)