Ceftriaxone과 연관된 소아의 담도 오니(biliary sludge) 1례

윤재균,이현희,신영규,정지태,독고영창,Yoon, Jae Kyun,Lee, Hyun Hee,Shin, Young Kyoo,Choung, Ji Tae,Tockgo, Young Chang 대한소아감염학회 1997 Pediatric Infection and Vaccine Vol.4 No.2

Ceftriaxone, an effective third generation cephalosporin with a wide range of antimicrobial activity, has become widely used by pediatricians for a variety of bacterial infections including meningitis. It has been associated with the development of sludge or stone in the gallbladder of some patients treated with this drug. Ceftriaxone associated biliary sludge has unusual acoustic characteristics and resembles gallstone. The sludge can cause symptoms such as cramping abdominal pain, and disappears after stopping ceftriaxone administration. Because of these seemingly confusing observations, it is important for the clinicians to recognize these findings that ceftriaxone treatment can cause. We report a case of ceftriaxone associated biliary sludge in Korean children. A 6-year-old girl who was treated for meningitis with ceftriaxone (100mg/kg/day) developed cramping upper abdominal pain from 5th hospital day. Physical examination, liver function tests and X-ray revealed no specific abnormal findings. But abdominal ultrasound revealed high amplitude echogenic sludge with prominent post-acoustic shadow in gallbladder and its diameter was 1.5cm. We stopped ceftriaxone administration and tried conservative care. Abdominal cramping pain subsided after 3 days of ceftriaxone removal. Second abdominal ultrasound confirmed the disappearance of sludge at 3 weeks later.

청소년기의 홍역 특이 IgG

윤재균,신영규,이기형,정지태,독고영창,Yoon, Jae Kyun,Shin, Young Kyoo,Lee, Kee Hyoung,Choung, Ji Tae,Tockgo, Young Chang 대한소아감염학회 1997 Pediatric Infection and Vaccine Vol.4 No.1

목 적 : 청소년기의 홍역 특이 IgG 항체의 혈중 농도를 측정하여 연령 증가에 따른 흥역 특이 IgG 항체 양성를 및 항체 역가를 알아보고, 홍역 유행 예방을 위한 자료를 제시하고자 본 연구를 시행하였다. 방 법 : 1996년 5월부터 7월까지 12세~17세의 서울 시내 3개 중,고등학교 학생 216명 (남:110, 여:106)을 대상으로 혈액을 채취하여 효소결합면역흡착검사(ELISA)로 흥역 특이 IgG를 측정하였다. 홍역 특이 IgG 농도는 정해진 방법에 따라 110AU/m1이상인 경우 항체 양성으로 판정하였다. 결 과 : 홍역 특이 IgG 양성률은 전체적으로 91.2%였으며, 12세 94.7%, 13세 82.8%, 14세 83.8%, 15세 91.8%, 16세 95.8%, 17세 100%였고, 연령별로 유의한 차이는 없었다. 항체 양성자들의 평균 흥역 항체 역가(펑균${\pm}$표준펀차 AU/ml)는 전체적으로 $256{\pm}90$이었으며, 12세 $281{\pm}119$, 13세 $248{\pm}86$, 14세 $263{\pm}93$, 15세 $249{\pm}86$, 16세 $270{\pm}88$, 17세 $225{\pm}78$이었고, 연령별로 유의한 차이는 없었다. 결 론 : 청소년기에 홍역 특이 IgG 양성율은 91.2%로 청소년중 상당수가 홍역 유행시 이환이 가능한 상태임을 보여주었다. 이에 대한 대책으로 청소년에 대한 재접종을 고려해야하며 향후 재접종의 효과에 대한 연구가 필요할 것으로 생각된다. Purpose : To determine the age-specific seropositivity and the level of measles specific IgG in vaccinated adolescents, the measles specific IgG titers were measured from the sera of junior & senior high school students in Seoul, Korea. Methods : From May to July in 1996, 216 sera were collected from junior & senior high school students(male : 110, female : 106) aged 12 to 17 years who were vaccinated and had no history of natural measles. Measles specific IgG titers were measured using ELISA method($SIA^{TM}$ Measles IgG Kit, Sigma Co. St. Louis, Mo). Results : The seropositivity of measles specific IgG in vaccinated adolescents aged 12 to 17 years was 91.2%. There were no significant correlations between age and seropositivity as well as between age and measles specific IgG level. Conclusions : We consider that our data suggest the necessity of revaccination of measles in adolescents. Further considerations should be required to establish an appropriate revaccination method and to evaluate the efficacy of revaccination of previously vaccinated adolescents.

청소년기의 홍역 특이 lgG

윤재균 ( Jae Kyun Yoon ),신영규 ( Young Kyoo Shin ),이기형 ( Kee Hyoung Lee ),정지태 ( Ji Tae Choung ),독고영창 ( Young Chang Tockgo ) 대한소아감염학회 1997 Pediatric Infection and Vaccine Vol.4 No.1

목적: 청소년기의 홍역 특이 IgG 항체의 혈중 농도를 측정하여 연령 증가에 따른 홍역 특이 IgG항체 양성률 및 항체 역가를 알아보고, 홍역 유행 예방을 위한 자료를 제시하고자 본 연구를 시행하였다. 방법: 1996년 5월부터 7월까지 12세~17세의 서울 시내 3개 중, 고등학교 학생 216명 (남: 110, 여: 106)을 대상으로 혈액을 채취하여 효소결합면역흡착검사(ELISA)로 홍역 특이 IgG를 측정하였다. 홍역 특이 IgG 농도는 정해진 방법에 따라 110AU/ml 이상인 경우 항체 양성으로 판정하였다. 결과: 홍역 특이 IgG 양성률은 전체적으로 91.2%였으며, 12세 94.7%, 13세 82.8%, 14세 83.8%, 15세 91.8%, 16세 95.8%, 17세 100%였고, 연령별로 유의한 차이는 없었다. 항체 양성자들의 평균 홍역 항체 역가(평균±표준편차 AU/ml)는 전체적으로 256±90이었으며, 12세 281±119, 13세 248±86, 14세 263±93, 15세 249±86, 16세 270±88, 17세 225±78이었고, 연령별로 유의한 차이는 없었다. 결론: 청소년기에 홍역 특이 IgG 양성율은 91.2%로 청소년중 상당수가 홍역 유행시 이환이 가능한 상대임을 보여주었다. 이에 대한 대책으로 청소년에 대한 재접종을 고려해야하며 향후 재 접종의 효과에 대한 연구가 필요할 것으로 생각된다. Purpose: To determine the age-specific seropositivity and the level of measles specific IgG in vaccinated adolescents, the measles specific IgG titers were measured from the sera of junior & senior high school student in Seoul, Korea. Methods: From May to July in 1996, 216 sera were collected from junior & senior high school students (male: 110, female: 106) aged 12 to 17 years who were vaccinated and had no history of natural measles. Measles specific IgG titers were measured using ELISA method (SIA(TM) Measles IgG Kit, Sigma Co. St. Louis, Mo). Results: The seropositivity of measles specific IgG in vaccinated adolescents aged 12 to 17 years was 91.2%. There were no significant correlations between age and seropositivity as well as between age and measles specific IgG level. Conclusions: We consider that our data suggest the necessity of revaccination of measles in adolescents. Further considerations should be required to establish an appropriate revaccination method and to evaluate the efficacy of revaccination of previously vaccinated adolescents.

소아 천식 교육 프로그램 개발을 위한 모델 제시

윤재균(Jae Kyun Yoon),정순미(Soon Mi Chung),정지태(Ji Tae Choung) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1997 소아알레르기 및 호흡기학회지 Vol.7 No.1

목 적 : 천식 치료의 발전으로 기대되는 천식의 역학적 변화와는 달리 전세계적으로 천식의 유병률과 사망률은 증가하고 있다. 이런 상황에서 천식 관리의 다른 대안으로 천식교육 프로그램이 개발되었으며, 긍정적인 평가를 받고 있다. 본 연구는 일차적으로 천식 아동의 부모들을 대상으로 하는 성인 교육 프로그램의 모델을 기획하여 궁극적으로 우리나라 현실에 맞는 소아 천식 교육 프로그램을 개발하고자 한다. 방 법 : 성인 교육 방법의 문제인 기획, 집행, 평가 등 세 가지 단계중 본 연구는 그 중 첫 번째 단계인 프로그램의 기획에 중심을 두어 수행하고자 한다. 그 첫 단계로 천식 아동의 부모중 참가를 회망하는 천식 아동의 어머니들을 대상으로 어머니교실을 계획하였다. 1 시간 일정의 수업을 4일간 시행하며, 수업은 각 시간마다 강의와 토론, 실습의 순서로 진행된다. 대상 선정에 있어 부모의 교육 정도와 경제적인 여건은 감안하지 않았으며, 대상 인원은 매회 20명 이내로 제한하였다. 결 과 : 프로그램의 내용은 1일차 천식이란 무엇인가?, 2일차: 천식의 치료는 어떻게 하는가?, 3일차: 천식 발작의 예방은 어떻게 하는가?, 4일차. 천식 발작이 왔을때는 어떻게 해야 할까요?로 구성하였다. 결 론 .: 이번 연구에서는 천식 교육 프로그램의 개발을 위하여 부모들을 대상으로 하는 부모 교육 부분 모델을 제시하는 바이며, 이를 바탕으로 천식 아동의 어머니 교실의 시행을 계획하고 있고, 추후에는 천식 교육 프로그램의 효과에 대한 객관적인 평가적 연구의 시행이 필요하리라 생각된다. Purpose : The size of the burden placed on all concerned, the chronicity of the disorder, and the importance of patient compliance in optimal management make asthma an excellent target for the development of patient education programs. Despite the usefulness and the need of the asthma education programs, there is no asthma education programs developed in Korea. In order to develop the education programs for childhood asthma, we offer a model for educating parents, as the first step. Methods: Mostly, adult education programs consist of 3 components-planning, implication, evaluation. At first, we are going to plan the asthma education programs for parents of the patients. 20 Volunteers in mothers will be gathered in one class. The curiculum is made of four 1- hour sessions. During the each session, mothers will be taught about the asthma, discuss the shared experiences and practice the skills. Results : This model consists of 4 sessions such as the definition of asthma, the treatment-medicines and correct use of inhalation devices, prevention and the management of acute episodes. Conclusions : Use of this education model will achieve better control of childhood asthma by leading the parents and patients to participate actively in their asthma treatment. The effects of this program will be assessed by a formal objective evaluation using a pretest, posttest experimental research design.

IgG4 결핍증이 의심되는 2 례

김재용(Jae Young Kim),윤재균(Jae Kyun Yoon),정지태(Ji Tae Choung),독고영창(Young Chang Tockgo) 대한소아알레르기호흡기학회 1996 소아알레르기 및 호흡기학회지 Vol.6 No.1

At the present time, IgG subclass deficiency is not a clearly defined disease. Some individuals with IgG subclass deficiency have no clinical disease, whereas others do. Recurrent sinusitis, otitis, pneumonia by Pneumococcus, Staphylococci, H. influenzae develop at the patient of IgG4 deficiency. We experienced two suspicious cases of IgG4 deficiency in a 16 months and a 32 months old male patients who were presented with recurrent respiratory tract infection history. At the immunological examination, the former decreased the level of total IgG (not a deficiency level) and IgG4, the latter decreased the level of IgG4, with the normal level of total IgG. We report two suspicious cases of IgG4 deficiency with brief review of related literature.

성인기의 홍역 특이 IgG

최정훈,신영규,정지태,독고영창,윤재균,Choe, Jeong-Hoon,Shin, Young Kyoo,Choung, Ji Tae,Tockgo, Young Chang,Yoon, Jae Kyun 대한소아감염학회 1999 Pediatric Infection and Vaccine Vol.6 No.2

목 적 : 우리나라 성인을 대상으로 홍역 특이 IgG 항체의 혈중 농도를 측정하여 각 연령층의 홍역특이 IgG 항체의 양성들과 항체 역가를 알아봄으로써 우리 나라의 홍역 집단 면역의 실태를 파악하고 궁극적으로 홍역 퇴치를 위한 자료를 제시하고자 본 연구를 시행하였다. 방 법 : 1997년 6월부터 7월까지 고대 안산 병원 외래 검사실을 방문한 20세 이상의 성인 156명(남 78, 여 78)을 대상으로 혈액을 채취하여 효소결합흡착검사(ELISA)로 홍역 특이 IgG를 측정하였다. 검사는 SIATM Measles IgG kit(Sigma Co. St Louis)를 이용하였으며, 홍역 특이 IgG의 농도는 정해진 방법에 따라 110AU/ml 이상인 경우 항체 양성으로 판정하였다. 결 과 : 1) 홍역 특이 IgG 항체 양성률은 전체적으로 94.9% 였고, 연령 별로는 20대 90.3%, 30대 96.9%, 40대 96.7%, 50대 95.5%, 60대 94.7%, 70대 95.5% 였으며, 연령별 항체 양성률에 있어서 유의한 차이는 없었다. 2) 전체 대상자들의 평균 홍역 항체 역가(평균${\pm}$표준편차, AU/ml)는 전체적으로 $238{\pm}84$이었으며, 연령별로 20대 $251{\pm}117$, 30대 $208{\pm}72$, 40대 $235{\pm}82$, 50대 $268{\pm}76$, 60대 $232{\pm}58$, 70대 $240{\pm}67$ AU/ml 등이었으며, 30대에서 평균 홍역 항체 역가가 다른 연령군에 비해 유의하게 낮았으나, 연령증가와 평균 홍역 항체 역가사이의 상관관계는 없었다. 결 론 : 성인기의 홍역 특이 IgG 양성률은 94.9%였으며, 연자들의 이전의 연구에서 나타난 소아 및 청소년기의 항체 양성률에 비해 성인층에서의 홍역에 대한 집단 연역이 높은 수준임을 보여주었다. 성인중 홍역 항체 음성률이 소아 및 청소년에 비해 낮고 또한 성인층에서 항체 음성인 경우에 대한 대책이 현실적으로 불가능한 만큼 앞으로는 백신 접종세대인 소아 및 청소년기의 홍역 유행의 주요 문제인 일차 백신 실패를 최소화하기 위한 더욱 더 많은 노력이 기울여 져야 할 것이다. Purpose : The aim of this study is to determine the age-specific seropositivity and the level of measles specific IgG in adults and to evaluate herd immunity to measles in Korea, the measles specific IgG were measured from the sera of adults over ages of 20 in Korea. Methods : 156 sera were collected from 156 out-patients over ages 20, who had visited clinical laboratory from June to July in 1997 at Korea University Ansan Hospital. The histories of natural measles or vaccination were not undertaken. Measles specific IgG titers were measured using ELISA method($SIA^{TM}$ Measles IgG Kit Co. St. Louis. Mo). Results : The results obtained from this study were as follows. 1) The seropositivity of measles specific IgG in adults was 94.9%. And there were no significant differences in their age and gender. 2) The mean measles-specific IgG titer was $238{\pm}84AU/mL$. And there were no significant differences in age and gender, except significant lower in 4th decades than other age groups. And there were no significant correlations between age and measles specific IgG level. Conclusion : In conclusion, a seropositivity of in adults was 94.9% which was higher than that of adolescents(91.2% in previous study), and antibody level was similar with adolescents. The herd immunity of the adults were considered to enough for protecting the transmission of measles in the community. For the eradication of measles in Korea, more efforts will be required to increase the vaccine coverage rate in children and adolescents.

우발적 분변흡인후 발생한 급성호흡곤란증후군 1 례

임지연(Jee Youn Lim),윤재균(Jae Kyun Yoon),이광철(Kwang Chul Lee),정지태(Ji Tae Choung) 대한소아알레르기호흡기학회 1996 소아알레르기 및 호흡기학회지 Vol.6 No.2

Acute Respiratory Distress Syndrome (ARDS) is disease entity characterized by physical signs of pulmonary insufficiency, impairment in gas exchange, and impaired lung compliance, and radiographic findings of diffuse pulmonary infiltrates due to increased permeability of alveolar-capillary membrane. ARDS is associated with a variety of predisposing disorders. In spite of improved respiratory support and intensive care, but mortality rates is still high. We have experienced a case of ARDS in 34 months old girl after fecal material aspiration by accident. This is the report on her clinical and radiologic findings with brief review of literatures.

건강한 학동기 아동의 폐기능검사 추정정상치

송대진(Dai Jin Song),한영나(Young Na Han),이장훈(Jang Hoon Lee),김형진(Hyung Jin Kim),임지연(Jee Youn Lim),피대훈(Dae Hun Pee),윤재균(Jae Kyun Yoon),정지태(Ji Tae Choung) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2002 소아알레르기 및 호흡기학회지 Vol.12 No.2

N/A Purpose: Appropriate reference values are needed for assessment of pulmonary function during childhood. We performed pulmonary function test with simple computerized spirometry to establish reference values of air flow rates in healthy Korean children. Methods: We examined 1,317 children aged 6 to 15 years at their schools by standardized method during May, 2001. The children with poor cooperation, respiratory symptom, and chronic disease were excluded. Regression analysis was applied for FVC, FEV1, PEF, FEF25-75% predicted from sex, age, standing height, weight, and body surface area. Results: In 1, 317 children(Male:716, Female:601) , the distribution of height was from 106.7 cm to 173.5 cm, weight was from 16.5 kg to 75.5kg. We could get regression equations and determinant coefficients between anthropometric parameters and air flow rates. In both sexes, height showed very close correlation with lung function variables, and FEV1 showed very close correlation with all anthropometric parameters. Reference values of pulmonary function test were generally higher in boys than in girls. Conclusion: After performing the pulmonary function test in healthy Korean children, we report their normal values of air flow rates and regression equations for the predicted values. Among anthropometric parameters, height showed most close correlation with lung function variables in both sexes.

실질성 간질환 소아의 혈청 Lipoprotein(a)와 지질의 변화

윤재균,이현희 關東大學校醫科大學醫科學硏究所 1998 關東醫大學術誌 Vol.2 No.1

The purposes of this study were to evaluate lipoprotein(a)[La(a)], lipids serum levels in children with parenchymal liver diseases and to determine the relationship between finding and serum aminotransferases, the marker of hepatic inflammation. Study population consisted of 20 patients with various parenchymal liver diseases aged 3 months to 16 years (12 boys and 8 girls). We measured the serum concentrarions Lp(a), total cholesterol, high density lipoprotein(HDL), low density lipoprotein(LDL), and aspartate aminotransferase(AST), alanine aminotransferase(ALT). The mean serum concentrations of Lp(a) in patient group / control were 4.83±4.38 /8.11±3.37 mg/dl and the difference was significant (p<0.05). The mean serum concentration of total cholesterol, HDL, LDL, in patient group / control group were 150.1±44.7 / 152.7±40.5 mg/dl, 33.5±13.9 / 43.6±11.2 mg/dl and 81.3±36.0 / 87.7± 3.7 mg/dl. There was significant difference in the mean concentrations of HDL between two groups. Our results shows that parenchymal live diseases are associated with decreased Lp(a) serum levels. Further-studies are needed to evaluate whether Lp(a) serum concentration might be clinically useful as a parameters of liver function.

신생아에서 용질배설에 관한 연구

김경범,박재현,최병민,이현희,윤재균 관동대학교 의과학연구소 2000 關東醫大學術誌 Vol.4 No.1

Purpose : Determination of urinary concentration in neonate is mandatory for precise management of fluid and electrolyte requirements. Although measurement of urine specific gravity has been proposed far monitoring fluid requirements, the reliability of specific gravity does not accurately predict urine osmolalities in the neonate period. So specific gravity should be checked by measuring the osmolality. Also the urinary excretion of creatinine has been used for the assessment of hydration state. We present the result of specific gravity, urine osmolality, urine creatinine in a spot urine sample during the first week of life as a reliable reference standard. Methods : Spontaneously-voided urine sample were obtained in 40 full term neonates. Two urine samples were available with a interval of 4 to 7days (A: 1st day, B: 4 - 7days), Urine sample was tested for specific gravity with a strip test. Also urinary osmolality, urinary creatinine, urinary creatinine/osmolality ratio were measured. Results : The mean of specific gravity tested by the strip test was 1.006±0.0040 (A) , 1.005±0.0036 (B). The mean of urine osmolality and creatinine were 177.7 ± 103.0 and 30.9±21.6 (A), 145.7 ±90.3 and 26.4± 17.7 (B). The mean of excretion rate of urine creatinine/osmolality ratio was 18.2 ±8.5 (A), 19.4 ±9.1 (B). There was correlation between urine specific gravity and osmolality in neonate(r=0.833(A), 0.842(B) p<0.001). Urinary creatinine/osmolality levels of the first urine samples were closely correlated with the second samples (r=0.617, p<0.001). Conclusion : Specific gravity of urine was enough to predict the osmolality in neonate. But Specific gravity should be checked by measuring the osmolality of urine. Urine osmolality and creatinine were spread over a wider range and did not used to urinary excretion of solute in neonate. Urinary creatinine/osmolality ratio can be used to standadise the urinary excretion on solute in the first week of life.