거대세포바이러스와 연관된 IgA 신병증을 Deflazacort와 정맥 면역글로불린으로 치료한 1례

윤서희,안승희,남궁미경,Yoon, Seo-Hee,Ahn, Seung-Hee,NamGoong, Mee-Kyung 대한소아신장학회 2008 Childhood kidney diseases Vol.12 No.2

거대 세포 바이러스가 IgA 신병증과 연관되었다는 설은 예로부터 논쟁거리가 되어 왔다. 일반적으로 ganciclovir는 거대세포바이러스의 치료제로 알려져 있으나, 부작용 및 독성 때문에 정상 면역을 가진 소아 환자들에게서는 잘 쓰이지 않는다. 본 저자들은 거대세포바이러스와 연관되었다고 생각되는 중증 IgA 신병증 환아를 deflazacort와 정맥 면역글로불린을 병용 투여하여 호전된 경우를 경험하여 보고하는 바이다. It has been suspected that various infections, including cytomegalovirus(CMV) infection, are associated with IgA nephropathy. In case of CMV infection, ganciclovir is known to be a treatment of choice for severe CMV infection in general. But ganciclovir has a lot of severe toxicity, so children with normal immunity are seldom treated by ganciclovir when CMV infection is suspected. On the other hand, intravenous immunoglobulin can also be used to treat CMV infection. We report a case of CMV-associated IgA nephrophaty, who was treated with deflazacort and Intravenous immunoglobulin therapy. An 11 years old boy suffered from gross hematuria for 3 days. He had proteinuria, thrombocytopenia(104,000/$mm^3$), antiplatelet antibody(+), impaired renal function and low serum albumin. His CMV serology was CMV-IgM/IgG(+/-) and urine CMV-PCR was positive. The renal histological findings revealed IgA nephropathy, WHO class II. His proteinuria persisted despite of deflazacort therapy(2.5 mg/kg/day). Later, intravenous immunoglobulin(1 g/kg) was administered twice. In two years, he showed no gross and microscopic hematuria, and his laboratory findings were also normalized.

청소년과 그들의 보호자를 대상으로 실시한 A형 간염 예방접종에 대한 지식 및 건강신념 연구

윤서희,이효연,김한울,공경애,김경효,Yoon, Seo Hee,Lee, Hyo Yeon,Kim, Han Wool,Kong, Kyoung Ae,Kim, Kyung-Hyo 대한소아감염학회 2013 Pediatric Infection and Vaccine Vol.20 No.3

목적: 최근 과거에 비해 A형 간염 발생률이 감소하고 있으나, 예방접종 도입 이전에 출생한 청소년들은 A형 간염의 대량발생 위험성이 있다. 본 연구는 A형 간염 예방접종을 시행하지 않은 청소년과 그 부모를 대상으로 A형 간염 예방접종에 대한 지식과 건강신념을 조사하였다. 방법: 만 13-19세의 A형 간염 과거력이 없고 예방접종을 시행하지 않은 건강한 청소년들과 그들의 보호자들을 대상으로 건강신념모델에 근거한 구조화된 설문지를 통해 조사를 실시하였다. 설문조사는 대상자들의 일반적 특성과 A형 간염 및 A형 간염 예방접종에 대한 지식과 건강신념을 조사하였고, 건강신념은 민감성, 심각성, 유익성, 장애성의 4가지 항목으로 측정하였다. 결과: 총 314명(157쌍)의 청소년과 보호자들이 모집되었고, 청소년과 보호자의 평균 나이는 각각 $16.0{\pm}1.6$, $45.6{\pm}4.7$세였다. 대상자의 A형 간염 및 예방접종에 대한 지식점수는 청소년, 보호자 각각 18점 만점에 평균 $6.4{\pm}3.7$점, $7.3{\pm}3.4$점이었으며, A형 간염과 예방접종에 관한 건강신념 세부항목들의 평균점수는 청소년과 보호자 각각 다음과 같았다. 민감성 점수(점수범위: 2-10점)는 $5.6{\pm}1.6$점과 $5.9{\pm}1.7$점; 심각성 점수(점수범위: 5-25점)는 $16.3{\pm}4.1$점과 $18.3{\pm}3.6$점; 유익성 점수(점수범위: 5-25점)는 $19.7{\pm}3.3$점과 $20.6{\pm}2.1$점; 장애성 점수(점수범위: 17-85점)는 $41.3{\pm}8.9$점과 $39.0{\pm}9.1$점이었다. A형 간염 예방접종을 시행하지 않은 가장 주된 원인은 청소년과 보호자 모두 'A형 간염 예방접종을 해야한다는 것을 알지 못했다'를 가장 많이 선택하였다. 결론: 청소년층의 A형 간염 대유행의 위험을 낮추고 접종률을 높이는 방안으로서 보호자가 함께 참여하는 반복적인 학교 보건교육이 필요하며, A형 간염 예방접종의 국가필수예방접종 도입도 고려되어야 하겠다. Purpose: Although the overall incidence of hepatitis A in Korea has been decreasing recently, the adolescents born before the introduction of the hepatitis A vaccine remain to be highly vulnerable to outbreak. This study examines the unvaccinated adolescents' and their parents' knowledge and health beliefs toward hepatitis A vaccination. Methods: Healthy adolescents aged 13-19 years old who had no previous history of hepatitis A vaccine and hepatitis A infection, and their parents or legal guardians were the subjects of the study. The survey was conducted using a structured questionnaire based on the Health Belief Model, and examined the subjects' demographics, knowledge, and health beliefs (i.e., perceived susceptibility, severity, benefits, and barriers). Results: We included 157 adolescents and their parents/guardians (mean age: $16.0{\pm}1.6$ and $45.6{\pm}4.7$ years, respectively). The average knowledge item score for adolescents and parents was $6.4{\pm}3.7$ and $7.3{\pm}3.4$ (out of 18), respectively. Similarly, average Health Belief Model item scores were: susceptibility, $5.6{\pm}1.6$ and $5.9{\pm}1.7$ (range: 2-10); severity, $16.3{\pm}4.1$ and $18.3{\pm}3.6$ (range:5-25); benefits, $19.7{\pm}3.3$ and $20.6{\pm}2.1$ (range:5-25); and barriers, $41.3{\pm}8.9$ and $39.0{\pm}9.1$ (range:7-85). The major reason for not undergoing hepatitis A vaccination was lack of knowledge about its importance. Conclusions: Refresher health lectures about hepatitis A and the vaccine are needed by both the adolescents and their parents. Furthermore, the inclusion of hepatitis A vaccine in the national immunization program should be considered to reduce the risk of hepatitis A outbreak and to raise the vaccination coverage among the adolescents in Korea.

소아에서 혈청 25-hydroxyvitamin D와 알레르기비염의 연관성

윤서희 ( Seo Hee Yoon ),김정윤 ( Jung Yoon Kim ),김윤희 ( Yoon Hee Kim ),박영아 ( Young A Park ),설인숙 ( In Suk Sol ),김민정 ( Min Jung Kim ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu-earn Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.6

Purpose: Vitamin D is known to play an important role in the regulation of the immune system and in the prevention of allergic disease. Herein, we examined the association between vitamin D and allergic rhinitis (AR) in children. Methods: A total of 72 aeroallergen-proven AR and 57 healthy control subjects who visited Severance Children`s Hospital between 2012 and 2014 were evaluated. The mean serum 25-hydroxyvitamin D (25(OH)D) level was measured in all subjects to evaluate their vitamin D status. Results: The mean serum 25(OH)D levels was significantly lower in patients with AR than in controls (19.5±6.4 ng/mL vs. 22.3±5.8 ng/mL, P=0.013). The incidence of AR is higher in the 25(OH)D-insufficient group (15-20 ng/mL) and in the 25(OH)D-deficient group (≤15 ng/mL) compared with the 25(OH)D-sufficient group (>20 ng/mL) (40.3% vs. 84.4% vs. 22.2%, P<0.001). There was no significant difference in the serum 25(OH)D level between subgroups with mild and moderate-to-severe AR symptoms (19.8±6.5 vs. 19.0±6.3, P=0.596). After adjusting for confounding factors, the lower serum vitamin D level groups had increased odds of AR compared with the 25(OH)D-sufficient group (odds ration [95% confidence interval]; 3.67 [1.29-10.38] in the 25(OH)D-insufficient group; P=0.014 and 6.04 [1.49-24.51] in the 25(OH)D-deficient group; P=0.012). Conclusion: The serum vitamin D levels were significantly lower in children with AR compared with healthy controls. Therefore, lower serum level of 25(OH)D may be associated with the development of AR. (Allergy Asthma Respir Dis 2016:4:423-428)

소아 열성 경련과 경도의 위장관염을 동반한 양성 경련의 임상적 고찰

윤서희(Seo Hee Yoon),안승희(Seung Hee Ahn),김황민(Hwang Min Kim),이해용(Hae Yong Lee),임백근(Baek Keun Lee),차병호(Byung Ho Cha) 대한소아신경학회 2008 대한소아신경학회지 Vol.16 No.2

목 적 : 열성 경련과 경도의 위장관염을 동반한 양성 경련은 소아 연령에서 흔한 신경학적 질환이다. 두 질환의 특성이 서로 비슷하지만 임상 양상 및 예후에 차이가 있다. 본 저자들은 소아의 급성 위장관염에 의한 열성 경련 및 경도의 위장관염을 동반한 양성 경련과 급성 위장관염 외의 원인에 의한 열성 경련의 임상적 특징과 예후를 알아보고자 하였다. 방 법 : 연세대학교 원주의과대학 부속 원주기독병원 소아청소년과에 2004년 1월 1일부터 2007년 12월 31일까지 입원 치료한 3개월에서 5세사이의 열성경련 및 양성 경련에 해당하는 569명을 대상으로 의무 기록을 통한 후향적 연구를 시행 하였다. 원인에 따라 급성 위장관염에 의한 열성 경련군(A), 경도의 위장관염을 동반한 양성 경련군(B), 급성 위장관염 외의 원인에 의한 열성 경련군(C)으로 분류하여 각 경련군 간에 임상적 특성과 예후를 비교하였다. 결 과 : 본 연구의 추적 관찰 기간은 평균 28.95±13.25개월이었으며, 평균연령은 A군; 1.51±1.10세, B군; 1.14±0.44세, C군; 1.84±1.33세였고 B와 C군 사이에 유의한 차이가 있었다(P<0.001). 각 군에서 성비의 차이는 없었으며(남녀비; A; 0.83:1, B;0.86:1, C; 1.2:1), 가장 흔한 경련의 종류는 전신성 경련이었다(A; 94.5%, B; 100%, C; 94.8%). 24시간 내 경련의 재발 빈도는 A; 1.53±0.88, B; 2.12±1.35, C;1.23±1.11회였고, B군이 A, C군보다 재발 빈도가 통계적으로 유의하게 높았다(P<0.001). 경련 지속시간은 세 경련군 사이에 유의한 차이는 없었다. 부모님이 열성경련의 과거력이 있는 경우는 C군(17.8%)에서 A군(14.5%)이나 B군(4.3%)보다 더 많았다(P<0.05). 평균 말초혈액백혈구 수는 C군(12,932±5,866 mmol/L)에서 A군(10,532±5,151 mmol/L)과 B군(8,686±3,053 mmol/L)보다 더 많았다(P<0.001). 그러나 평균 혈청 나트륨 수치, 비정상적인 신경 발달상태와 이상 뇌파 소견, 신경 영상 검사상 이상 소견의 빈도는 세 군간에 차이가 없었다. 로타바이러스 항원 양성은 A군(45.7%)과 B군(42.6%)에서 C군(14.5%)보다 더 빈도가 높았다 (P<0.05). 첫 경련 이후 열성 경련의 재발이 일어난 경우는 A; 9.1%, B;5.8%, C; 11.9%였으며, 첫 경련이후 비유발성 경련으로 재발이 일어난 경우는 A; 5.4%, B; 1.4%, C;1.6%이었다. 결 론 : 급성 위장관염에 의한 열성 경련, 경도의 위장관염을 동반한 양성 경련, 급성 위장관염 이외의 원인에 의한 열성 경련 사이에는 발병 연령, 24시간 내 반복 경련의 재발 빈도, 열성 경련의 가족력, 말초 혈액내 백혈구 수 및 로타바이러스 양성율에서 차이가 있었다. 세 군 모두에서 첫 경련 후에 비유발성 경련의 발현율은 낮아 그 예후가 양호하다고 할 수 있으나, 양성 경련과 급성 위장관염에 의한 열성 경련의 경우에 24시간 내에 경련의 재발 빈도가 높기 때문에 이런 환아가 내원할 경우에 급성기 경련의 재발을 위한 처치를 고려해야 할 것으로 사료되며, 많은 경우는 아니지만 비유발성 경련이나 열성 경련의 재발에 대해 보호자에 대한 설명이 필요할 것으로 사료된다. Purpose : Febrile Seizures and Benign convulsion with mild gastroenteritis(BCwMG) are common neurological disorders in children. We would like to know the clinical characteristics and prognosis of febrile seizure associated with acute gastroenteritis(A), BCwMG(B) and febrile seizure associated with a febrile illness not caused by acute gastroenteritis(C) in children. Methods : We reviewed the medical records of 569 pediatric patients aged from 3 months to 5 years that admitted to the Wonju Christian Hospital from 2004 to 2007 for febrile seizures or BCwMG. Results : The mean ages were A; 1.51±1.10 years, B; 1.14±0.44 years, C; 1.84±1.33 years. The most common seizure type was generalized seizure(95.4%). The average frequency of seizure was higher in B than A and C(A; 1.53±0.88, B; 2.12±1.35, C; 1.23±1.11 times/day, P<0.001). The incidence of positive parents history for febrile seizures was higher in A and C compared to B(A; 14.5%, B; 4.3%, C; 17.8%, P<0.05). The mean WBC count in peripheral blood was higher in C than A and B(A; 10,532±5,151, B; 8,686±3,053, C; 12,932±5,866 mmol/L, P<0.001). The positive rate of stool rotavirus antigen test was higher in A and B compared to C(A: 45.7%, B: 42.6%, C: 14.5%, P<0.05). But there were no statistically significant differences of sex ratio, duration of seizures, serum sodium level, abnormal neurodevelopmental status, rate of EEG and neuroimaging abnormalities among three groups. The recurrence rate of febrile seizure after the 1st seizure was A; 9.1%, B; 5.8%, C; 11.9% and unprovoked seizure was A; 5.4%, B; 1.4%, C; 1.6%. Conclusion : We consider prophylactic short term management of recurrent episodes of seizures within 24 hours, especially in febrile seizure associated with acute gastroenteritis and BCwMG. Also, It will be necessary to educate parents about the possibility of recurrence of febrile seizures or unprovoked seizures, although the risk is low.

한어 결과보어의 한국어 번역에 관한 연구

윤서희(Yoon Seo-Hee),성윤숙(Seong Yoon-Suk) 동북아시아문화학회 2009 동북아 문화연구 Vol.1 No.18

Chinese Resultant complements are very commonly used as a Chinese sentence, and also the characteristic structure system in modern Chinese syntactic. For the foreign students who study Chinese, the resultant complement is a major difficulty point, Korean native Chinese learners are also so. In the second language acquisition process, identify the corresponding sentence to the mother language, then translation and understanding is a basic way for each foreign learners to learn a foreign language. explore the different types of resultant Complement Sentence in Korean translation method, for Korean students, to help them correctly understand the resultant complement, are very realistic. In this paper, in order to try to resolve the defects caused by directly apply a fixed form of translation, in the study of resultant complement. in Korean translation, close connection with the resultant complement`s significance of grammar, semantics and the semantic point analysis, especially with the ambiguous in the statement resultant complement. And this paper also made a discuss of the relative translation

소아에서 human metapneumovirus 중증 폐렴으로 체외막산소화 장치를 적용한 1예

최선하 ( Sun Ha Choi ),윤서희 ( Seo Hee Yoon ),설인숙 ( In Suk Sol ),김민정 ( Min Jung Kim ),김윤희 ( Yoon Hee Kim ),신홍주 ( Hong Ju Shin ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu Earn Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2015 Allergy Asthma & Respiratory Disease Vol.3 No.6

We present the first case report of a child with human metapneumovirus (hMPV) pneumonia who survived by extracorporeal membrane oxygenation (ECMO) in Korea. A 26-month-old boy with a previous history of Lennox-Gastaut syndrome and delayed development suffered from respiratory failure after 4 days of fever, cough, and sputum. The boy underwent intubation and required ECMO application due to failure of conventional mechanical ventilation. He was on the ECMO support for 7 days. To our knowledge, this is the shortest period reported for ECMO application among successfully treated patients with hMPV infection accompanied by acute respiratory distress syndrome. This case highlights 2 clinical implications: the potentially fatal causative role of hMPV in respiratory failure in a pediatric population and the timely utilization of ECMO. (Allergy Asthma Respir Dis 2015;3:456-460)

소아 급성 호흡곤란증후군에서의 Berlin 정의

김수연 ( Soo Yeon Kim ),김윤희 ( Yoon Hee Kim ),설인숙 ( In Suk Sol ),김민정 ( Min Jung Kim ),윤서희 ( Seo Hee Yoon ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu?earn Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.4

Purpose: The revised Berlin definition (BD) showed better predictive validity for mortality in adults with acute respiratory distress syndrome (ARDS). We examined the validity of BD for pediatric ARDS as compared to the American-European Consensus Conference definition (AECCD). Methods: This single-center, retrospective study included 127 patients aged 1 month to 19 years who were admitted to the medical intensive care unit due to acute lung injury (ALI, n=31) or ARDS (n=96) using the AECCD. All patient characteristics and mortality rates were compared between the individual severity groups according to the BD and AECCD. Results: Sixty-four patients (50%) died. Mortality rates increased across the severity groups according to both definitions (26% in mild, 42% in moderate, and 75% in severe by the BD [P<0.001]; 26% in ALI non-ARDS and 58% in ARDS by the AECCD [P=0.002]). The mortality risk increased only for ‘severe ARDS’ (hazard radio for mortality, 2.56; 95% confidence intervals [CI], 1.14-5.78; P=0.023) after adjusting for confounding factors. The BD better predicted mortality, with an integrated area under the receiver operating characteristic curve (iAUC) of 0.651 (95% CI, 0.571-0.725), than the AECCD, with an iAUC of 0.584 (95% CI, 0.523-0.637). The pediatric risk of mortality (PRISM) III and pediatric index of mortality 3 scores were significantly different across BD severity groups, whereas only PRISM III scores were different according to the AECCD. Conclusion: The BD applied to children with ARDS. It could be adopted to severity classifications and predict pediatric ARDS mortality better than the AECCD. (Allergy Asthma Respir Dis 2016:4:257-263)

합병증을 동반한 기관지 땅콩 흡인에서 체외막산소화 장치를 통한 치료 1예

정재화 ( Jae Hwa Jung ),설인숙 ( In Suk Sol ),윤서희 ( Seo Hee Yoon ),김민정 ( Min Jung Kim ),김윤희 ( Yoon Hee Kim ),신홍주 ( Hong Ju Shin ),박한기 ( Han Ki Park ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.2

Foreign body aspiration commonly occurs, especially among children younger than 3 years of age. Most endobronchial foreign bodies may be easily removed by bronchoscopy and have a good prognosis. Despite advances in bronchoscopic procedures, difficulties in management of and complications from foreign body aspiration are still noted. We present a foreign body aspiration case with acute respiratory distress syndrome caused aspiration pneumonia, which was successfully treated by bronchoscopy under extracorporeal membrane oxygenation (ECMO). ECMO can be an effective and potentially life-saving method in complicated foreign body aspiration with uncompensated respiratory failure. (Allergy Asthma Respir Dis 2016;4:140-144)

소아 급성호흡곤란증후군에서 체외순환막장치 적용에 대한 RESP, PRESERVE, ECMOnet 점수 체계의 유용성

안원기 ( Won Kee Ahn ),한정호 ( Jung Ho Han ),김윤희 ( Yoon Hee Kim ),설인숙 ( In Suk Sol ),윤서희 ( Seo Hee Yoon ),김민정 ( Min Jung Kim ),김경원 ( Kyung Won Kim ),손명현 ( Myung Hyun Sohn ),김규언 ( Kyu-earn Kim ) 대한소아알레르기호흡기학회 2017 Allergy Asthma & Respiratory Disease Vol.5 No.3

Purpose: With increasing use of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) in children, development of standardized strategies for survival prediction has become crucial; however, this has not been accomplished yet. We evaluated the adult scoring systems for survival prediction used for their applicability in pediatric ARDS and validated them. Methods: A total of 11 children with ARDS receiving ECMO from 2013 to 2014 were evaluated with adult scoring systems, including the Respiratory Extracorporeal-membrane-oxygenation Survival Prediction (RESP), the PRedicting dEath for SEvere ARDS on VV-ECMO (PRESERVE), and the ECMOnet scores. We compared the scores on these scales and the clinical characteristics between survivors and nonsurvivors. Results: Eight of the 11 children died (72.7%). The PRESERVE score (survivors vs. nonsurvivors: 2 vs 5.25, P=0.048), and the ECMOnet score (4.1 vs. 5.63, P=0.048) were lower in survivors than in nonsurvivors. They correctly predicted mortality prediction. There was no significant difference in the RESP score between survivors and non-survivors (-4.33 vs -2.62, P=0.63). The parameters that showed significant differences in this study were peak inspiratory pressure, platelet, and delta neutrophil index. All children who were under immunocompromised conditions, such as those with tumors, or underwent hematopoietic stem cell transplantation died. The immunocompromised status should be considered an important factor for survival prediction in children with ARDS. Conclusion: This is the first pilot study to apply the survival prediction scoring system to pediatric ARDS with ECMO. It is necessary to establish and modify the survival prediction score system for pediatric ARDS with ECMO. (Allergy Asthma Respir Dis 2017:5:141-146)

가족에서 발생한 제1형 뎅기바이러스에 의한 뎅기열

장지영,정은교,윤서희,김경효,최희정 Ewha Womans University School of Medicine 2013 EMJ (Ewha medical journal) Vol.36 No.S

We report two cases of dengue fever due to DENV-1 in the family members who returned from Manila, Philippines. Case 1: A 41-year-old female visited the clinic with a general weakness. She had a fever for 5 days. When she came back to Korea, her fever had subsided. The immunoglobulin M (IgM)-capture enzyme-linked immunosorbent assay for dengue virus was positive. Case 2: A 11-year-old female was admitted to the pediatric department after reporting symptoms of fever and abdominal pain upon returning from the Philippines. The RT-PCR result for DENV-1 was positive in blood, but IgM came out negative. Dengue fever should be suspected for those who have returned from an endemic area with reports of febrile illness and rash, particularly if thrombocytopenia, leukopenia, elevated serum aminotransferase are present. Using RT-PCR and serological test, the precise diagnosis should be made and proper management should be given to prevent secondary complications.