3개월 미만 요로감염 영아에서 중증 방광 요관 역류의 예측인자

이대용,김나연,조희연,김지은,심소연,손동우,전인상,차한,Yi, Dae-Yong,Kim, Na-Yeon,Cho, Hee-Yeon,Kim, Ji-Eun,Sim, So-Yeon,Son, Dong-Woo,Jeon, In-Sang,Cha, Han 대한소아신장학회 2008 Childhood kidney diseases Vol.12 No.2

목 적 : 최근 I, II 등급 방광 요관 역류의 임상적 중요성이 적어지면서 요로감염 영아 모두에게 침습적인 VCUG를 시행하여야 하는지에 대한 의문이 제기되어 있다. 요로감염이 있는 3개월 미만의 영아를 대상으로 III 등급 이상의 중증 방광 요관 역류에 대한 예측인자를 알아보고 VCUG의 시행 여부에 대한 임상적인 근거를 제시하고자 하였다. 방 법: 2004년 1월부터 2007년 9월까지 가천의과대학교 병원에 입원해서 요로감염으로 치료받은 3개월 미만의 환아 중 초음파 검사와 VCUG를 시행받은 환아를 대상으로 하였다. 후향적인 의무기록의 검토를 통하여 I 군(III-V 등급의 방광 요관 역류)과 II 군 (정상 혹은 I, II 등급의 방광 요관 역류) 간의 임상적 지표와 영상 검사 결과를 비교 검토하였다. 초음파의 민감도와 특이도 및 양성예측도와 음성예측도, 그리고 위험도와 우도비를 구하여 중증 방광 요관 역류에 대한 진단적 가치를 알아보았다. 결 과: 총 54명(남아 41명, 여아 13명) 의 대상아 중에서 I군이 14명, II군이 40명이였다. I 군에서 CRP가 높았고(6.11$\pm$5.18와 3.27$\pm$3.45, P=0.025) 비정상적인 초음파 소견이 많았지만(71.4%와 22.5%, P=0.002) 관련 인자를 보정한 후에는 초음파만이 통계적인 유의성이 있었다(P=0.002). 원인균, 균혈증 및 DMSA 이상소견은 두 군간에 유의한 차이가 없었다. 중증 방광 요관 역류에 대한 초음파의 민감도는 71.4%(41.9-91.4), 특이도는 77.5%(61.5-89.1), 위험도는 6.9(1.58-30.41)이었고 음성예측도는 88.6%(73.2-96.7), 음성우도비는 0.37(0.16-0.86)을 나타내었으나($\alpha$=0.05, 검정력 94%) III 등급의 방광 요관 역류4명은(28.6%)은 정상적인 초음파 소견을 보였다. 결 론 : 3개월 미만의 요로감염이 있는 영아에서 중증 방광 요관 역류 에 대해 VCUG를 대체할만한 예측인자를 규명하지 못했다. 따라서 모든 요로감염 영아(3개월 미만)에서 VCUG의 시행이 필요할 것으로 생각된다. Purpose : Our aim was to investigate the predictive factors for detecting grade III-V vesicoureteral reflux(VUR) in young infants less than 3 months with urinary tract infections (UTI). Methods : Data of infants who underwent ultrasonography and VCUG between January 2004 and September 2007 were reviewed. Age, gender, incidence of bacteremia, C-reactive protein(CRP) and imaging studies were compared between group I(grade III-V VUR) and group II (normal or grade I and II VUR) retrospectively. Sensitivity, specificity, positive and negative predictive values, odds ratio, and likelihood ratio of ultrasonography for high grade VUR were evaluated. Results : Among 54 enrolled infants(41 males, 13 females), 14 infants were group I and 40 infants were group II. In the group I, CRP level was significantly higher(6.11$\pm$5.18 vs. 3.27$\pm$3.45, P=0.025), and there were more ultrasonographic abnormal findings(71.4%, vs. 22.5%, P=0.002) compared with group II. However, ultrasonography was the only significant factor after adjusting with logistic regression(P=0.002). Incidence of bacteremia and abnormal DMSA findings were not significantly different in two groups. Sensitivity, specificity, and odds ratio of ultrasonography was 71.4%, 77.5%, 6.9 respectively. Negative predictive value was 88.6% and negative likelihood ratio was 0.37. Ultrasonography had significant negative likelihood ratio for grade III-V VUR, but missed 4 infants with grade III VUR. Conclusion : We could not find any alternative predictive factors to reduce VCUG in detecting high grade VUR. Therefore, VCUG must be considered in young infants less than 3 months with UTI.

비단열 모세관의 전도 열저항 실험 및 전산 해석

이대용(Dae Yong Yi),Debasish Sarker,정지환(Ji Hawn Jeong) 대한기계학회 2010 대한기계학회 춘추학술대회 Vol.2010 No.11

This Paper presents experimental and CFD analysis of conductive thermal resistance of capillary tube-suction line heat exchanger(SLHX). Distilled water was circulated through a SLHX and heat transfer occurs due to temperature difference between the capillary tube-side and the suction line-side. The convective thermal resistances of both sides are subtracted experimental results show that the conductive thermal resistance reaches about 1.5% of total thermal resistance without mass flow rate.

비단열 모세관의 전도 열저항 측정 및 해석

이대용(Dae Yong Yi),Debasish Sarker,정지환(Ji Hawn Jeong) 대한설비공학회 2010 대한설비공학회 학술발표대회논문집 Vol.2010 No.6

This paper presents experimental analysis of conductive thermal resistance of capillary tube-suction line heat exchanger or SLHX. Distilled water was circulated through a SLHX and heat transfer occurs due to temperature difference between the capillary tube-side and the suction line-side. The convective thermal resistances of both sides are subtracted from the total thermal resistance to get the conductive thermal resistance of the 3type of the SLHX. The results show that the conductive thermal resistance reaches about 1.5%, 53%, 8.5% of the total thermal resistance.

비단열 모세관 접합방법이 증기압축식 냉동사이클 성능에 미치는 영향 해석

이대용(Dae-Yong Yi),박상구(Sang-Goo Park),김현정(Hyun-Jung Kim),정지환(Ji-Hawn Jeong) 한국마린엔지니어링학회 2009 한국마린엔지니어링학회지 Vol.33 No.8

복통이 있는 소아청소년에서 식도염의 유병률과 위험인자

권현정,이대용,류일,조강호,손동우,차한,Kwon, Hyun-Jung,Yi, Dae-Yong,Ryoo, Eell,Cho, Kang-Ho,Son, Dong-Woo,Tcha, Han 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.2

목 적: 소아에서 식도염은 성인과 달리 나이별로 다양하고, 비특이적인 증상이나 징후를 보인다. 또한 식도염을 진단하기 위한 상부 위장관 내시경과 조직 생검을 시행하는 것도 쉽지 않다. 이에 본 연구에서는 소아에서 식도염의 유병률과 조직 검사의 필요성 및 위험 인자에 대해 알아보고자 하였다. 방 법: 2006년 1월부터 2007년 12월까지 가천의대 길병원 소아과에 내원하여 급만성 상복부 복통을 보인 환자들 266명을 대상으로 문진 및 신체 검사, 상부 위장관 내시경과 함께 식도 및 위 조직 생검을 시행하였다. 식도염의 진단은 조직 검사로 확진 하였으며, H. pylori 감염 여부는 CLO 검사, H&E 염색과 Giemsa 염색 혹은 요소호기검사로 확인하였다. 식도염과 관련된 위험인자 및 내시경 소견과 조직학적 소견의 관련성을 비교분석하였다. 결 과: 상부 내시경과 조직 생검을 시행 환자 266명 중 조직학적 식도염 환자는 전체 266명 중 53명(19.9%)이었으며, 남자 18명(34.0%), 여자 35명(66.0%)으로 평균 나이는 11.6${\pm}$0.87세였다. 내시경 소견의 민감도는 41.5%, 특이도는 77.0%, 양성 예측도 31.0%였다. 조직학적 식도염 환자 중 역류성 식도염은 50명, 호산구성 식도염은 2명, 캔디다 감염증에 의한 식도염은 1명이었다. 모든 연령에서 복통이 가장 흔한 증상으로 나타났으며, 8세 이하 환아들에서 구토가 의미 있게 많았다(p<0.05). 봄에 좀더 많이 내원하는 것으로 나타났으며(OR 2.5, 95% CI 1.2544 to 4.8286), H. pylori 감염군에서 식도염의 가능성이 의미 있게 높게 나타났다(OR 2.5, 95% CI 1.1598 to 4.2798). 결 론: 상부 위장관 증상이 있는 환자에서 상부 위장관 내시경 검사를 시행할 때, 특히 학령 전기 환자에서 구토를 동반한 위장관 증상이 있거나, 봄에 내원시, H. pylori 감염이 있을 경우 식도염의 가능성이 더욱 높으므로 식도 조직 생검을 고려해야 할 것으로 생각된다. Purpose: Children with esophagitis express a variety of nonspecific symptoms and signs depending on their age, and diagnosis is limited because gastrointestinal endoscopy (GFS) and biopsy are difficult to perform. The aim of this study was to examine the prevalence of esophagitis in children with upper abdominal pain, to determine the necessity of esophageal biopsy, and to evaluate the associated risk factors. Methods: We reviewed 266 pediatric patients with upper abdominal pain who underwent history-taking, physical examination, and GFS with esophageal and gastric biopsies between January 2006 and December 2007. Esophagitis was confirmed on biopsy. We analyzed the risk factors for histologic esophagitis and the necessity of esophageal biopsy. Results: The prevalence of esophagitis was 19.9% (53/266 patients). The sensitivity and specificity of endoscopic diagnosis were 41.5% and 77%. Of 53 patients with histologic esophagitis, reflux esophagitis was seen in 50 patients, eosinophilic esophagitis was seen in 2 patients, and esophageal candidiasis was seen in 1 patient. Vomiting was a significant factor in patients under 8 yr of age (p<0.05). H. pylori infection was documented in 41.5% of patients with histologic esophagitis, compared with 58.5% of patients not infected with H. pylori (p<0.05). The possibility of histologic esophagitis was higher in patients with H. pylori infection (OR 2.5, 95% CI 1.2544 to 4.8286) and in those who visited in the spring (OR 2.5, 95% CI 1.2544 to 4.8286). Conclusion: We believe esophageal tissue biopsy should be performed in pediatric patients with upper gastrointestinal symptoms who are undergoing GFS and stomach tissue biopsy, especially preschoolers and H. pylori-infected children in the spring.

Urine endothelin-1의 소아 요로 감염 환아에서의 진단적 유용성

기형민,이대용,윤기욱,임인석,하태선,Kee, Hyung Min,Yi, Dae Yong,Yun, Ki Wook,Lim, In Seok,Ha, Tae-Seon 대한소아신장학회 2014 Childhood kidney diseases Vol.18 No.1

목적: 요로감염은 특별한 가 없는 영아나 소아에서 흔한 세균 감염으로 요로감염은 소변배양검사를 통하여 진단되며, 빠르고 정확한 진단과 치료가 중요하다. 하지만 배뇨조절이 잘 안되는 소아에서 진단 과정에서 오류가 발생하기 쉽다. Urine Endothelin-1 (ET-1)은 사구체 혈관 손상 시 사구체간질 세포에서 나오는 물질로 이를 통하여서 요로감염의 조기 진단의 유용성을 알아보고자 하였다. 방법: 2012년 7월부터 2013년 7월까지 13개월간 발열을 주소로 중앙대학교 병원 소아청소년과에 내원한 18세 미만의 70명의 환자를 대상으로 전향적으로 비교 분석하였다. 소변배양검사상 요로감염으로 진단된 실험군과 요로감염으로 진단되지 않은 대조군으로 나누었으며, 0.3 mL의 소변을 이용하여 Enzyme-linked immunosorbent assay 방법을 통해 urine ET-1을 정량적으로 측정하였다. 결과: 실험군은 45명이었고, 대조군은 25명이었으며, 실험군의 소변배양검사에서 Escherichia coli 42명, Klebsiella pneumonia 2명, Enterococcus faecalis 1명이 배양되었으며, 상부요로감염은 19명, 하부요로감염은 26명이었다. Urine ET-1은 실험군에서 평균 $1.41{\pm}0.35$ pg/mL, 대조군에서 $0.33{\pm}0.07$ pg/mL으로 통계학적으로 유의한 차이를 보였으며(P=0.04), 상부와 하부 요로감염간의 정량적 수치에서 유의성은 없었다(P=0.552). Urine ET-1과 혈청 C-reactive protein, 혈청 내 백혈구 간의 연관성은 없었다(pearson 상관계수: 0.24, 0.19). 결론: Urine ET-1은 적은 양의 소변으로도 검사 할 수 있으며, 요로감염을 진단하는 데에 유의한 결과를 보였다. Purpose: Urinary tract infections (UTIs) are the most common source of bacterial infections in infants and young children. Accurate diagnosis and treatment is important because of their association with renal scarring, which can lead to complications. Urine endothelin-1 (ET-1) is the major renal isoform produced and released by renal mesangial cells in response to glomerular injury. This study aimed to investigate whether urinary levels of ET-1 can be used as a biomarker for UTI diagnosis. Method: We conducted a prospective study using medical records of 70 patients below the age of 18 years, who visited Chung-Ang University Hospital from July 2012 to July 2013. We classified the patients into the UTI and control groups based on urine culture studies. The UTI group was further divided into upper and lower UTI groups using 99m-Technetium dimercaptosuccinic acid scintigraphy. Urine ET-1 was measured using enzyme linked immunosorbent assay with 0.3 mL urine. Results: The UTI and control groups were comprised of 45 and 25 patients, respectively. Mean urine ET-1 levels were significantly higher in the UTI group than in the control group ($1.41{\pm}0.35$ pg/mL vs. $0.33{\pm}0.07$ pg/mL, P =0.04). There was no significance difference in the quantitative value between the upper and lower UTI groups (P =0.552). There was no correlation between urine ET-1 and serum C-reactive protein (Pearson correlation [R]=0.24), urine ET-1 and serum white blood cell count (R=0.19). Conclusion: Our study suggests that urine ET-1 can be used for early diagnosis of UTI in children.

비단열 모세관의 형상 변경에 따른 소형 냉동 사이클 성능 해석

남기원(Ki-Won Nam),이대용(Dae Yong Yi),박상구(Sang-Goo Park),정지환(Ji Hawn Jeong),김윤수(Lyun-Su Kim) 대한설비공학회 2009 대한설비공학회 학술발표대회논문집 Vol.2009 No.-

The present simulation focuses on the effect of the shape of capillary tube-suction line heat exchangers(SLHX), The results in the three cases of the SLHX types show that both of the location and length of heat exchange section influence the coefficient of performance(COP) and cooling capacity. Simulation shows the COP may be improved by 4.6% and the cooling capacity may be improved by 13.6% in the Lateral type.

생후 90일 미만 영아의 요로 감염에서 세균성 수막염의 동반 가능성

황준호,김수영,이나미,이대용,윤신원,채수안,임인석,박지영,Hwang, Jun Ho,Kim, Su Yeong,Lee, Na Mi,Yi, Dae Yong,Yun, Sin Weon,Chae, Soo Ahn,Lim, In Seok,Park, Ji Young 대한소아감염학회 2022 Pediatric Infection and Vaccine Vol.29 No.2

Purpose: Urinary tract infections (UTIs) are the most common serious bacterial infections in young infants. Lumbar puncture (LP) has been used to diagnose coexisting meningitis in infants under 90 days of age with suspected UTI in many hospitals. However, the incidence of bacterial meningitis associated with UTIs is low. We aimed to describe the prevalence of concomitant bacterial meningitis in young infants with UTIs. Methods: The medical records of infants with the first episode of UTI admitted to the Chung-Ang University Hospital from January 2010 to December 2019 were retrospectively reviewed. Infants aged < 90 days who underwent LP with initial evaluation were included. Demographic and clinical features, laboratory findings, and imaging findings were collected and analyzed. Results: Eighty-six infants with UTIs were enrolled in the study. The median age was 61.5 days (interquartile range, 42.3-73.8 days) and boys (90.7%) were predominant. Escherichia coli was the most common pathogen (n=80, 93.0%) and followed by Klebsiella species (n=5, 5.8%). Fifteen (18.1%) specimens produced extended spectrum β-lactamase (ESBL). Five (5.8%) infants had positive blood culture results. Seven (8.1%) infants showed pleocytosis in the cerebrospinal fluid, but none had coexisting bacterial meningitis. Twenty-four (30.8%) infants showed renal dilatation or hydronephrosis on ultrasonography. Dimercaptosuccinic acid (DMSA) scans revealed cortical defects in 17 (21.3%) infants while voiding cystourethrography revealed vesicoureteral reflux in 6 (46.2%) infants. Conclusion: Co-existing bacterial meningitis was not observed in young infants with UTIs. LP could not be routinely performed considering the clinical condition of <90 days old UTI patients.

급성 결핵성수막염의 양상을 보이는 속립성 결핵에 동반된 신경 베쳇증후군

은성훈(Seonghoon Eun),김영덕(Young Duck Kim),이대용(Dae Yong Yi),이나미(Na Mi Lee),윤신원(Sin Weon Yun),채수안(Soo Ahn Chae),임인석(InSeok Lim ),최응상(Eung Sang Choi) 대한소아신경학회 2016 대한소아신경학회지 Vol.24 No.1

A 14-year-old girl diagnosed with Behçet's disease 15 months previously presented at the emergency department with severe headache, fever, and vomiting. Chest radiographic and computed tomography findings were consistent with miliary tuberculosis, and pleocytosis and increased protein levels were found on examination of cerebrospinal fluid (CSF). Tuberculous meningitis associated with miliary pulmonary tuberculosis was suspected, and a four-drug regimen for tuberculosis plus intravenous dexamethasone was initiated. However, negative results of real-time polymerase chain reaction and CSF cultures led us to reconsider our initial diagnosis. On brain magnetic resonance imaging, the results supported neuro-Behçet's syndrome rather than tuberculous meningitis. However, it is unclear how miliary tuberculosis complicated neuro-Behçet's syndrome because the patient had no history of tuberculosis or contact with patients with tuberculosis, and had not used any immunosuppressive agents such as anti-tumor necrosis factor-alpha drugs. This is a very rare case of neuro-Behçet's syndrome associated with miliary tuberculosis. More commonly, cases of neuro-Behçet's syndrome presenting with features mimicking acute tuberculous meningitis have been reported. Neuro- Behçet's syndrome should be considered in patients with a history of Behçet's disease presenting with signs of meningeal irritation.

Comparison of the Head-up Tilt Test in the Children and Adult

류나리 ( Na Li Yu ),이나미 ( Na Mi Lee ),이대용 ( Dae Yong Yi ),윤신원 ( Sin Weon Yun ),채수안 ( Soo Ahn Chae ),임인석 ( In Seok Lim ) 중앙대학교 의학연구소 2017 中央醫大誌 Vol.42 No.1

Objective: To compare the difference of children (under 18 year-old) and adult (over 40 year-old) in head-up tilt test (HUTT) positive patients. Methods: All patients diagnosed as vasovagal syncope in HUTT from January 2005 to December 2015 in Chung-Ang university hospital. Any patients with underline disease excluded. Results: The mean age was 13.5 years (from 7 to 17 years) and 59.3 years (from 40 to 85 years) in children and adult respectively in HUTT positive patients. There was no sex differences in children and adult [male: 57 (35.4%) vs 65 (43%) (p =0.167)]. The positive rate of passive test was statistically different in two groups [54 patients (33.5%) vs 23 patients (15.2%) (p <0.001)]. The highest heart rate (HR) and delta HR in Type I positive in passive test was statistically different in two groups [highest HR: 107.8 bpm vs 91.0 bpm (p <0.05); increase delta HR: 35.8 bpm vs 22.5 bpm (p <0.001); decrease delta HR 38.0bpm vs 25.6 bpm (p <0.05)]. The HR values except at baseline in Type I positive in provocation test were statistically different in two group [highest HR: 138.4 bpm vs 113.5 bpm (p <0.001); lowest HR: 88.7 bpm vs 77.3 bpm (p <0.05); increase delta HR: 64.5 bpm vs 44.4 bpm (p <0.001), decrease delta HR: 49.7 bpm vs 36.1 bpm (p <0.001)]. Conclusion: The positive rate of passive test and HR differences in HUTT were statically different in two groups. Chung-Ang J Med 2017; 42(1): 17-23