신생아 발작의 발견 및 진단

은백린 대한신생아학회 2009 Neonatal medicine Vol.16 No.1

Seizures are the most common clinical manifestation of a neurologic insult during the neonatal period. Neonatal seizures continue to present a diagnostic and therapeutic challenge to pediatricians because the recognition and classification of neonatal seizures remains problematic, particularly when clinicians rely only on clinical criteria. Neonatal seizures can permanently disrupt neuronal development, induce synaptic reorganization, alter plasticity, and “prime” the brain to increased damage from seizures later in life. Since neonatal seizures, particularly status epilepticus, predict an increased risk for later epilepsy and other neurologic sequelae, accurate diagnoses are needed for aggressive antiepileptic drug use. The present review summarizes the pathophysiology, etiology, and diagnosis of neonatal seizures.

소아에서 뇌파검사의 유용성

은백린 대한소아청소년과학회 2001 Clinical and Experimental Pediatrics (CEP) Vol.44 No.4

소아 영역의 건강보험제도 개선안

은백린 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.4

The Korean Health Insurance (KHI) has been introduced since 1977 and it took only 12 years that KHI had accomplished the total coverage of Korean population. The remarkable success of KHI can be compared with other OECD countries which had taken some 30 years to over 100 years to establish the total coverage of the population. Life expectancy at birth and the infant mortality rate in Korea in 2005 both surpassed the average figures of the OECD countries, The main reason for the success of KHI can be delineated with the three characteristics in KHI development; low premiums, low benefits, and low fee-schedule charges. However, these three characteristics of KHI, which had been the key for the rapid development of the system, have become terrible disadvantages for the stable development of KHI. The dissatisfaction and discontent of health care providers are ever increasing. The population is reluctant to pay more premiums though it seems essential for the better care coverage. The health care system has been heavily distorted toward high technology-oriented expensive care. There should be several factors seriously tackled for the secure development of KHI in the future. This paper will review a brief history of KHI development, and I would like to make a suggestion of health insurance for children.

Brain Protection in epileptic seizures

은백린 연세대학교 의과대학 장애아동연구소 1999 장애아동연구소논문집 Vol.12 No.-

영유아 건강검진 사업의 이해

은백린 한국모자보건학회 2007 한국모자보건학회 학술대회 연제집 Vol.2007 No.2

현행 영유아 및 소아청소년 건강검진제도의 평가 및 대안

은백린,문진수,은소희,이혜경,신손문,성인경,정희정 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.3

Purpose:Recent changes in the population structure of Korea, such as rapid decline in birth rate and exponential increase in old-aged people, prompted us to prepare a new health improvement program in children and adolescents. Methods:We reviewed current health screenings applied for children and adolescents in Korea and other developed countries. We collected and reviewed population-based data focused on mortality and morbidity, and other health-related statistical data. We generated problem lists in current systems and developed new principles. Results:Current health screening programs for children and adolescents were usually based on laboratory tests, such as blood tests, urinalysis, and radiologic tests. Almost all of these programs lacked evidence based on population data or controlled studies. In most developed countries, laboratory tests are used only very selectively, and they usually focus on primary prevention of diseases and health improvement using anticipatory guidance. In Korea, statistics on mortality and morbidity reveal that diseases related to lifestyle, such as obesity and metabolic syndrome, are increasing in all generations. Conclusion:We recommend a periodic health screening program with anticipatory guidance, which is focused on growth and developmental surveillance in infants and children. We no longer recommend old programs that are based on laboratory and radiologic examinations. School health screening programs should also be changed to meet current health issues, such as developing a healthier lifestyle to minimize risk behaviors—for example, good mental health, balanced nutrition, and more exercise. 목 적:최근 우리나라도 선진국형 저출산 고령사회로 변하고 있어 차세대의 건강한 국민 확보를 위하여 국민 개개인의 평생건강의 기초가 되는 영유아 및 소아청소년에 대한 건강증진사업의 필요성이 강조되고 있다. 이에 실효성 있고 표준적인 영유아 및 소아청소년(학교) 건강검진 지침(guideline)의 개발이 필요하다. 방 법:국내 검진 현황 파악 및 문제점 도출 후, 영유아 및 소아청소년 시기의 국내 질병부담 정보와 최근에 실시된 국가 역학조사자료를 검토하고, 선진국에서의 검진 체계를 비교 분석하였다. 이후 실효성 있는 영유아 및 청소년(학교) 건강검진 지침 개발을 위한 방안을 모색하였다. 결 과:1) 국내 영유아 관련 건강검진제도는 보건소를 중심으로 실시되고 있으나, 사업 대상이 경제적 취약계층으로 제한되어 있을 뿐 아니라 빈혈검사, 소변검사, 청각검사, 혈압측정 등 검사 중심으로 구성된 질병발견 위주의 검진체계이다. 2) 학교 건강검진제도 또한 성인에서의 검진제도와 유사하게 혈액검사, 소변검사, 방사선학검사 등 검체 검사 중심의 질병발견 위주 검진체계로 구성되어 있어 실효성 있는 건강검진 항목 개발과 검진빈도, 검진방법 등에 대한 근거중심의 체계가 부족한 실정이다. 3) 선진국의 영유아 검진체계에서는 검체 검사를 선별적으로만 실시하는 것을 원칙으로 하고 있다. 4) 선진국의 학교건강검진은 각국의 정책에 따른 차이는 있으나 기본적으로 검체검사나 방사선학검사 등의 질병에 대한 검사보다는 병력 청취와 질병 예방 및 건강한 생활습관과 환경 조성을 위한 상담과 교육에 중점을 두고 있다. 결 론:이상의 결과에서 대안으로 다음과 같은 검진 체계를 제시한다. 1) 급격히 성장․발달하는 영유아에서는 성인과는 달리 혈액검사, 소변검사로 유병률이 낮은 질병 발견에 초점을 맞추기보다는 이 시기에 가장 중요한 성장 및 발달을 주기적으로 평가하고, 연령별로 예측 가능한 예방차원의 육아 지침(anticipatory guidance)을 제공하는 질병예방 위주의 검진을 영유아 건강검진사업의 목표로 설정하여야겠다. 2) 학생검진도 과거의 만성질환이나 성인병 조기 발견을 위한 검사보다는 급격한 신체적, 정신사회적 성장과 발달 과정에서 흔한 건강 문제와 위해 요소를 파악하여 건강한 생활 습관 및 건강관리 능력을 배양할 수 있도록 지속적인 상담과 교육으로 발전시키는 것을 목표로 하여야겠다.

영유아 건강검진 사업의 이해

은백린,김성우,김영기,김정욱,문진수,박수경,성인경,신손문,유선미,은소희,이혜경,임현택,정희정,Eun, Baik-Lin,Kim, Seong Woo,Kim, Young Key,Kim, Jung Wook,Moon, Jin Soo,Park, Su Kyung,Sung, In Kyung,Shin, Son Moon,Yoo, Sun Mi,Eun, So Hee,Lee, H 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.3

The mission of National Health Screening Program for Infant and Children is to promote and improve the health, education, and well-being of infants, children, families, and communities. Although the term 'diagnosis' usually relates to pathology, a similar diagnostic approach applies to the child seen primarily for health supervision. In the case of health, diagnosis determines the selection of appropriate health promoting and preventive interventions, whether medical, dental, nutritional, educational, or psychosocial. Components of the diagnostic process in health supervision include the health 'interview'; assessment of physiological, emotional, cognitive, and social development (including critical developmental milestones); physical examination; screening procedures; and evaluation of strengths and issues. Open and informed communication between the health professional and the family remains the most significant component of both health diagnosis and health promotion. Families complete medical history forms at their health supervision visit. Family-friendly questionnaires, checklists, and surveys that are appropriate for the child's age are additional tools to improve and update data gathering. This type of information helps initiate and inform discussions between the family and the health professional. This article provides a comprehensive review of current National Health Screening Program for Infant and Children in Korea.

청소년의 혈청 지질에 관한 연구

은백린,독고영창 고려대학교 의과대학 1993 고려대 의대 잡지 Vol.30 No.3

Compelling evidence exists that the atherosclerotic process begins in childhood and progresses slowly into adulthood, at which time it leads frequently to coronary heart disease ; that high blood cholesterol levels early in life play a role in the development of adult atherosclerosis; that eating patterns and genetics affect blood cholesterol levels and coronary heart disease risk ; and that lowering levels in children and adolescents will be beneficial. A cross sectional study on serum lipids in Korean adolescents was carried out in three areas in 1992. Serum lipids, i. e. total cholesterol, HDL, cholesterol and triglyceride concentrations were determined and LDL cholesterol and so called atherogenic index were calculated in 465 adolescents aged 12 to 17 years. The results are as follows ; 1. The mean serum total cholesterol level is 141.83±28.53mg/dl(male 133.95±25.90mg/dl, female 150.20±28.87mg/dl), HDL cholesterol 49.84±10.93mg/dl(male 48.18±9.95mg/dl, female 51.61±11.65mg/dl), LDL cholesterol 74.32±26.38mg/dl(male 68.59±24.70mg/dl, female 80.40±26.80mg/dl), triglyceride 92.33±47.03mg/dl(male 93.09±61.09mg/dl, female 91.52±24.58mg/dl) and atherogenic index 1.98±0.89(male 1.89±0.78, female 2.06±0.98). 2. In male adolescents, the 75th percentile for total cholesterol is 150.0mg/dl, for LDL cholesterol 83.0mg/dl, and for triglyceride 100.0mg/dl. The 95th percentile for total cholesterol, LDL cholesterol, and triglyceride are 179.4mg/dl, 111.2mg/dl and 170.0mg/dl, respectively. The 5th and 25th percentile for HDL Cholesterol are 33.0mg/dl and 41.0mg/dl, respectively. 3. In female adolescents, the 75th percentile for total cholesterol is 167.0mg/dl, for LDL cholesterol 97.0mg/dl and for triglyceride 105.0mg/dl. The 95th percentile for total cholesterol, LDL cholesterol, and triglyceride are 200.8mg/dl, 131.4mg/dl and 142.0mg/dl, respeetively. The 5th and 25th percentile for HDL Cholesterol are 36.0mg/dl and 44.0mg/dl, respectively. 4. The serum levels of total cholesterol, HDL cholesterol and LDL cholesterol are higher in female than male adolescents except triglycerides. 5. There are significant correlations between serum total cholesterol level and height, between HDL cholesterol level and weight, arm circumference, Kaup index, obesity index, triceps skinfold, abdominal skinfold and subscapular skinfold, between triglyceride concentration and diastolic blood pressure. Atherogenic index also has correlations with arm circumference, Kaup index, obesity index, triceps skinfold, abdominal skinfold and subscapular skinfold.

혈소판 감소성 자반증을 동반한 수두 2례

은백린,송해준 최신의학사 1994 最新醫學 Vol.37 No.12

저산소성 허혈증에 의한 신생 백서 뇌손상후 E-selectin 발현에 관한 연구

은백린(Baik-Lin Eun) 대한소아신경학회 1998 대한소아신경학회지 Vol.5 No.2

목적 : adhesion molecule 중 selectin 군은 염증 반응화 허혈 후 재관류시 내피 세포와 배혈구의 상호작용을 개시하는데 중요한 역할을 한다. 저산소성 허혈증 후 증성구가 뇌조직에 축적되는 정확한 기전에 대해서는 아직 밝혀져 있지 않지만 흰쥐 미성숙 뇌를 이용한 저산소성 허혈증 실험모델에서 뇌 조직의 괴사가 일어나기 전에 중성구가 조직에 축적되며, 중성구를 혈중에 제거함으로서 저산소성 허혈증에 의한 뇌손상을 감소시킬 수 있었다. 본 연구는 E-selectin이 신생 백서에서 저산소성 허혈증에 의한 뇌손상을 유도하는지 알아보기 위하여 E-selectin 유전자 및 단백질 표현의 변화를 관찰하였다. 방법 : 7일된 Sprague-Dawley 백서(n=48)를 사용하여 Methoxyflurane 마취하에 우측 총경독맥(common carotid artery)을 결찰하고 약 1시간동안 보육기에서 회복시킨 후, 37℃ 수조에 일부가 잠겨있는 유리용기에서 약 2시간 30분동안 8% 산소에 노출시켰다. 대조군으로는 단순 총경동맥 결찰군, 단순 저산소 노출군, 정상군 등을 이용하였다. 허혈 및 저산소 후 0, 1, 2, 4, 8, 12, 24, 48시간 뒤 백서 대뇌의 좌측과 우측 대뇌피질, 해마, 선조체로부터 각각 전(total) RNA를 추출한 뒤 RT-PCR을 통해 E-selectin 유전자 발현의 변화를 확인하였고, 허혈 및 저산소 후 4, 8시간 뒤 면역 세포 화학 분석을 통해 단백질의 표현을 관찰하였다. 결과 : E-selectin 유전자 발현은 뇌피질, 해마, 선조체 모두에서 허혈 및 저산소증 후 4시간과 8시간 뒤에 가장 높았고, 그후 감소하여 48시간 이후 더 이상 검출되지 않았으며, 단백질의 표현 역시 8시간 후 특히 뇌손상의 주변 부위에서 혈관분포와 유사한 모양으로 다량 검출되었다. 대조군에서는 모두 E-selectin 유전자가 검출되지 않았다. 결론 : 미성숙 뇌에서 저산소성 허혈성 뇌손상시 E-selectin 유전자와 단백질의 발현에 관한 이 같은 결과는 중성구의 동원(recruitment)과 이에 연속되는 뇌손상과 실험적으로 일치하여 E-selectin이 신생 백서에서 저산소성 허혈증에 의한 뇌손상을 유발하는데 중요한 역할을 하는 것으로 생각된다. Background and Purpose : The selectins play a role in the initiation of endothelium-leukocyte interaction; endothelial expression of E-selectin is induced by ischemia-reperfusion-like conditions in vitro. Neutrophils accumulate in post-hypoxic-ischemic neonatal rat brain prior to the evolution of necrosis and neutrophil depletion attenuates hypoxic-ischemic brain injury; the mechanisms leading to post-hypoxic-ischemic neutrophil accumlation are unknown. We hypowhesized that E-selectin might mediate post-hypoxic-ischemic injury in the immature brain; thus, we evaluated E-selectin gene expression by RT-PCR and protein accumulation by immunocytochemistry in post-hypoxic ischemic neonatal(postnatal day 7) rat brain. Methods : Neonatal rats(n=48) underwent right carotid ligation followed by 2.5h in 8% O₂; this procedure typically produces ipsilateral striatal, hippocampal and cortical infarction. Controls included carotid ligation alone, hypoxia alone, and neither hypoxia nor ligation. For RNA extraction, rats were killed 0, 1, 2, 4, 8, 12, 24 and 48 h post-hypoxia-ischemia. For immunocytochemistry, rats were killed at 4 and 8 h. Results : Ipsilateral(right-sided) E-selectin mRNA was markedly elevated in cortex, striatum and hippocampus at 4 and 8 h post-hypoxia-ischemia; expression decreased at 12 and 24 h and was no longeer detectable at 48 h. E-selectin protein was detected predominantly in right striatum 8 h post-hypoxia-ischemia, in a pattern consistent with a vascular distribution. E-selectin mRNA was barely detectable in any controls. Conclusions : The temporal and spatial profiles of post-hypoxia-ischemia E-selectin mRNA and protein expression are consistent with a role in post-hypoxia-ischemia neutrophil recruitment and in the evolution of subsequent brain injury.