중환자실 재입실이 의미하는 것

조중범 ( Joong Bum Cho ) 대한천식알레르기학회(구 대한알레르기학회) 2014 Allergy Asthma & Respiratory Disease Vol.2 No.2

영아 우유알레르기에서 식이제한을 시행한 모유수유와 저항원성 분유수유가 면역관용 획득에 미치는 영향의 비교

조중범 ( Joong Bum Cho ),서정민 ( Jung Min Suh ),이정현 ( Jung Hyun Lee ),한영신 ( Young Shin Han ),안강모 ( Kang Mo Ahn ),이상일 ( Sang Il Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2011 소아알레르기 및 호흡기학회지 Vol.21 No.3

Purpose: The aim of this study was to compare the effects of breast milk (BM) feeding with those of maternal cow milk (CM) restriction and extensively hydrolyzed CM formula feeding on the duration of CM allergy as well as changes in specific immunoglobulin E (IgE) levels in infants with CM allergy. Methods: Children diagnosed with CM allergy before 12 months age and BM fed were included retrospectively. CM allergy was diagnosed by CM specific IgE over 0.35 kU/L and 1) obvious clinical symptoms, 2) a suspicious history with positive provocation test, or 3) CM specific IgE over the 95% positive predictive value and subsequent documented report of clinical symptoms. The patients were classified into three groups by feeding regimen: BM group, extensively hydrolyzed formula (eHF) group, or mixed feeding (MF) group. Analysis of the groups regarding the duration of food allergy and changes in CM specific IgE was then performed. Results: Forty-six children were included. Twenty-four children were in the BM group, 13 children were in the eHF group, and 9 children comprised the MF group. Thirteen patients reached tolerance. The means of the tolerance age were 69.7±5.4 months in the BM group, 36.6±4.6 months in the eHF group, and 38.2±7.9 months in the MF group. The survival curves of tolerance showed significant difference among the three groups (P=0.04). CM specific IgE levels measured at a second time period were 9.6 kU/L (interquartile range, 3.6-44.2) in the BM group, 2.0 kU/L (1.0-18.0) in the eHF group, and 4.8 kU/L (0.2-10.4) in the MF group (P=0.04). Conclusion: Feeding regimen influences the duration of CM allergy. Exclusively BM-fed children achieved tolerance later than eHF-fed children. Prospective and randomized controlled studies are required. [Pediatr Allergy Respir Dis(Korea) 2011;21:207-214]

아토피피부염의 중증도 변화에 따른 삶의 질 변화

조중범 ( Joong Bum Cho ),이정현 ( Jung Hyun Lee ),서정민 ( Jung Min Suh ),유정석 ( Jung Seok Yu ),이호석 ( Ho Seok Lee ),박은아 ( Eun Ah Park ),김현미 ( Hyun Mi Kim ),장은영 ( Eun Young Chang ),김지현 ( Ji Hyun Kim ),한영신 ( Youn 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.1

Purpose: The aim of this study was to longitudinally examine the correlation between the change of atopic dermatitis (AD) severity and the change of quality of life (QOL). Methods: We assessed AD severity and QOL of patients and their families, by a prospective followed up for at least 12 months. AD severity was assessed, using the scoring of atopic dermatitis (SCORAD) index. A questionnaire based on dermatitis family impact (DFI), infants` dermatologic quality of life (IDQoL) and children`s dermatology life quality index (CDLQI) were used to determine QOL Results: Seventy-nine AD patients were assessed for total and objective SCORAD and DFI. Among them, 45 patients that were less than 36 months old completed IDQoL and 13 patients that were equal to or more than 36 months old completed CDLQI. Objective SCORAD (oSCORAD) were correlated with DFI (r=0.235), IDQoL (r=0.602) and CDLQI (r=0.589) (P<0.05). At the 2nd interview, median oSCORAD (from 17.4 to 7.8), DFI (from 23.0 to 18.0) and IDQoL (from 9.0 to 6.0) were significantly decreased (P<0.01). The changes of oSCORAD were linearly related with the change of IDQoL (P<0.01), but neither with DFI (P=0.356) nor with CDLQI (P=0.267). Of the 64 patients with decreased oSCORAD, food allergy was accompanied more frequently in those with an increased DFI than those with a decreased DFI (60.7% vs. 27.8%, P<0.01). Conclusion: In this longitudinal study, the improvement of AD severity is correlated with the improvement of the patient`s QOL, under the age of 3. To improve the family`s QOL, we need to find out accompanying factors, such as food allergy, and to support the family accordingly.

소아 복막 투석 환자에서 발생한 복막염의 경험적 항생제 치료에 관한 연구

이상구,조중범,손영배,박성원,김수진,진동규,백경훈,Lee, Sang-Goo,Cho, Joong-Bum,Sohn, Young-Bae,Park, Sung-Won,Kim, Su-Jin,Jin, Dong-Kyu,Paik, Kyung-Hoon 대한소아신장학회 2008 Childhood kidney diseases Vol.12 No.2

목 적 : 최근 소아 복막염에서 methicillin에 대한 저항성을 갖는 균주가 증가하고 있어서 the International Pediatric Peritonitis Registry(IPPR) 가이드라인에 따른 초치료 경험적 약제의 선택의 효용성에 대해서 논란이 되고 있다. 본 연구에서는 소아에서 발생한 복막염을 중심으로 ISPD 가이드라인을 따른 경험적 항균제 선택의 치료 효과적 유용성을 분석하였다. 방 법 : 2001년 1월부터 2007년 12월까지 7년간 삼성 서울 병원에서 복막 투석을 받은 경험이 있는 환자들을 대상으로 복막염을 일으킨 원인 균의 미생물학적 특성과 ISPD 가이드라인에 따라서 복막염을 치료 했을 때의 임상적 경과 등에 대해서 의무 기록을 후향적으로 조사하였다. 결 과: 복막 투석을 받은 42명의 환자 중, 21명에서 48례의 복막염이 발생하였다. 복막염 발생율은 one episode over 35.3 patient-months였으며, 복막염 발생 전까지의 평균 투석 기간은 18.06$\pm$15.81개월이었다. 그람 양성균에 의한 복막염이 전체의 58.3%를 차지하였으며, 이중 S. aureus와 coagulase negative staphylococcus가 가장 많았다. 동정된 그람 양성균들 중 35.7%는 1세대 cephalosporin에 저항성을 보였으나 4세 이하의 환자에서는 50%가 저항성을 보였다. 그람 음성균 중에서는 E. coli가 가장 많았다. 동정된 모든 균들은 현재 사용중인 1세대 cephalosporin과 ceftazidime의 병합 요법에 64.8%가 감수성을 보였다. 결 론: 국내 소아 복막 투석 환자에서 발생한 복막염에서 경험적 항생제 초치료로 현재 사용중인 1세대 cephalosporin과 ceftazidime의 병합 요법은 여전히 효과적이다. 그러나 4세 미만의 환자에서는 경험적 항생제 초치료로 1세대 cephalosporin 대신 glycopeptide를 사용하는 것이 더 효과적일 것으로 생각된다. Purpose : This study aims to verify the effectiveness of initial empirical antibiotic choice recommended by the International Society for Peritoneal Dialysis(ISPD) guide among Korean children. Methods : We have collected data on peritonitis from January 2001 to December 2007 in Samsung Medical Center. Results : Of the 42 patients, 48 episodes of peritonitis had occurred in 21 patients. The rate of peritonitis was one episode over 35.3 patient-months. Mean dialysis duration before peritonitis was 18.06$\pm$15.81 months. Gram-positive organisms accounted for 58.3% of all episodes. Of the gram-positive organisms, the most common pathogen was Staphylococcus aureus(29.2%), the next common pathogens were Coagulase negative staphylococcus(14.6%) and Streptococcus species(6.3%). 35.7% of gram-positive pathogens were resistant to 1st cephalosporin. However, in patients younger than 4 years old, 50% of gram-positive pathogens were resistant to 1st generation cephalosporin. 10 episodes of peritonitis were methicillin-resistant and were treated by vancomycin. Of the gram-negative organisms, E. coli was the most common (8.3%). 64.8% of all pathogens were sensitive to cephalothin or ceftazidime. Conclusion : The empirical therapy with 1st generation cephalosporin and ceftazidime can be also effective to peritoneal dialysis associated peritonitis in Korean children. However, in patients younger than 4 years old, glycopeptide should be considered as the first empirical therapy in Korean children.

소아청소년에서 기관지 내시경을 통해 진단된 기관지 결핵의 임상 경과

서정민 ( Jung Min Suh ),조중범 ( Joong Bum Cho ),이정현 ( Jung Hyun Lee ),안강모 ( Kang Mo Ahn ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.2

목적: 소아청소년 폐결핵 환자에서 기관지 내시경을 일상적으로 사용하지 않지 때문에 소아청소년 폐결핵 환자에서 기관지 결핵의 발병률은 정확하게 알려져 있지 않다. 본연구에서는 기관지 내시경을 통해서 진단된 기관지 결핵 환자의 발병률과 임상 경과를 알아보고자 하였다. 방법: 1996년 1월부터 2011년 1월까지 삼성서울병원에서 폐결핵을 진단 받은 18세 미만의 환자 중에서 기관지 내시경을 통해 기관지 결핵을 진단 받은 환자를 대상으로 하였다. 의무 기록을 후향적으로 검토하여 성별, 나이, 결핵 피부 반응, 결핵 환자와 접촉 유무, 내원 당시의 주 호소 증상, 단순 흉부 방사선 검사 소견, 객담 혹은 위 흡인액 그리고 기관지 세척액의 미생물학적 검사 결과, 진단 시의 기관지 내시경 소견 및 추적 기관지 내시경 검사 소견 그리고 치료 결과를 조사하였다. 결과: 전체 101명의 폐결핵 환자 중에서 기관지 내시경을 통해 16명이 기관지 결핵으로 진단받았다. 이 중 여자가 9명(56.2%)였으며 진단 당시의 중앙 나이는 11.2세 (범위, 5개월-16.1세)였다. 결핵 환자와의 접촉력이 있었던 경우가 6명(37.5%)이었고, 투베르쿨린 반응 검사에서 양성을 보인 경우가 9명(56.2%)이었으며, 단순 흉부 방사선 촬영상 폐경화를 보인 경우가 7명(43.8%)으로 가장 많았다. 객담이나 위 흡인액으로 결핵균 검사를 시행한 12명 중에서, 항산균 도말 검사에서 4명(33.3%), 배양 검사와 중합 효소연쇄 반응 (polymerase chain reaction, PCR)검사는 각각 7명(58.3%)에서 양성 반응을 보였다. 기관지 세척액으로 결핵균 검사를 시행한 16명 중에서 항산균 도말 검사에서 7명(43.8%), 배양 검사는 8명(50%), 그리고 PCR 검사는 13명(81.3%)에서 양성 반응을 보였다. 기관지 내시경 소견에 따른 분류 상 건락성 괴사형이 7명(43.8%)으로 가장 많았다. 9명(56.3%)은 추적 관찰에서 기관지 협착을 보였으며, 4명(25%)은 폐 절제술을 받았다. 기관지 내시경 소견 상 섬유 협착형과 종양형이 건락성 괴사형에 비해서 기관지 폐쇄로 진행하는 경우가 더 많았다. 결론: 국내 소아청소년의 기관지 결핵 발병률은 폐결핵 환자의 15.8%였다. 기관지 결핵은 기관지 폐쇄의 합병증을 생기게 하여 수술적 치료까지 필요한 상황으로 이어질 수 있으므로, 합병증을 줄이기 위한 조기 진단과 적절한 치료가 필요할 것으로 사료된다. Purpose: The incidence of endobronchial tuberculosis in children is unknown, due to the inconsistent implementation of bronchoscopy in pediatric patients with pulmonary tuberculosis. In this study, our aim was to determine the incidence and clinical course of endobronchial tuberculosis in children. Methods: We performed a retrospective chart review of patients less than 18 years of age, who was diagnosed with endobronchial tuberculosis via fiberoptic bronchoscopy. Results: Out of the 101 patients with pulmonary tuberculosis, 16 patients had endobronchial tuberculosis. The median age at diagnosis was 11.2 years (range, 5 months to 16.1 years). Tuberculin skin test was positive in 9 cases (56.2%), and 6 patients (37.5%) had a history of household contact with tuberculosis. Consolidation lesion was common in the simple chest radiographs of patients with endobronchial tuberculosis. According to the bronchoscopic finding, actively caseating type was most common (43.8%). Nine of the 16 patients of endobronchial tuberculosis progressed to bronchial obstruction and 4 patients underwent pneumonectomy or lobectomy. Fibrostenotic and tumorous type tend to progress to endobronchial obstruction compared with actively caseating type. Conclusion: The incidence of endobronchial tuberculosis in pediatric pulmonary tuberculosis was 15.8%. Early detection and effective treatment of endobronchial tuberculosis are important to decrease the secondary complication, such as bronchial obstruction.

스마트폰 사용시간과 스트레스 간의 관계에서 자기통제감의 매개효과 분석

김종태(Jong-Tae Kim),조현(Hyun Cho),조중범(Joong-Bum Jo),김대진(Dai-Jin Kim) 한국중독정신의학회 2020 중독정신의학 Vol.24 No.2

Objectives : This study aimed to investigate the mediating effects of self-control on the relationship between smartphone use time and stress. Methods : This study was conducted on 1,669 19 to 39-year-old men and women who participated in online research in 2017. We clarified the relationship among smartphone use time, self-control, and stress and tested the mediation model. Correlation analysis was performed to identify the relationship between the main variables. To test the mediating effect of self-control on the relationship between smartphone use time and stress, a structural equation model was implemented using the AMOS program. Results : There were significant correlations between the variables of smartphone use time, self-control, and stress. Self-control had a mediating effect (the indirect path coefficient 0.048, 95% CI: 0.022-0.080) in the relationship between smartphone use time and stress. Conclusion : This study showed that self-control could mediate smartphone use time and stress. Therefore, not only the convenience of using a smartphone but also the disadvantages (e.g., stress) that a smartphone can cause should be addressed.

진찰과 설문조사를 통한 초등학생의 아토피피부염 유병률 및 위험요인 비교

이정현 ( Jung Hyun Lee ),김은혜 ( Eun Hye Kim ),조중범 ( Joong Bum Cho ),김혜영 ( Hye Young Kim ),서정민 ( Jung Min Suh ),안강모 ( Kang Mo Ahn ),정해관 ( Hae Kwan Cheong ),이상일 ( Sang Il Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2011 소아알레르기 및 호흡기학회지 Vol.21 No.3

Purpose: The present study aimed to evaluate the accuracy of determining the prevalence of atopic dermatitis (AD) with a questionnaire by diagnosing AD with both a questionnaire and pediatricians` physical examinations and to determine the possible risk factors for AD. Methods: A survey was conducted from December 2008 to February 2009 in four elementary schools. The Korean version of the International Study of Asthma and Allergies in Childhood written questionnaire (WQ) was used to identify AD ever and AD during the last 12 months. Current AD was diagnosed by well-trained pediatricians according to the Hanifin and Rajka`s diagnostic criteria. A total of 2,729 children who completed the questionnaire and underwent a physical examination by pediatricians were included in this analysis. Results: According to the WQ, the prevalence of AD in the entire life and in the last 12 months was 18.4% and 12.9%, respectively. The prevalence of clinically diagnosed AD by pediatricians was 8.8%. There was a significant positive relationship between the prevalence of AD diagnosed by physical examination and past history of allergic rhinitis (adjusted odds ratio [aOR], 1.45), allergy history of the mother (aOR, 2.48), and AD history of the mother (aOR, 1.61). According to the WQ, there was also a significant positive relationship between the prevalence of AD in the last 12 months and past history of asthma (aOR, 2.55) and AD history of the mother (aOR, 1.71). Conclusion: Prevalence and risk factors of AD were different according to the survey methods. When prevalence of AD is determined with a questionnaire in the future, more careful attention should be used, because the result can be overestimated compared to the actual prevalence. Pediatr Allergy Respir Dis(Korea) 2011;21:186-196]