소아에서의 Adenovirus에 의한 호흡기 감염의 임상적 고찰

김홍근,함세창,남승연,고영재,안강모,이상길 대한소아청소년과학회 2000 Clinical and Experimental Pediatrics (CEP) Vol.43 No.2

Purpose : Adenoviral respiratory infection can develop a life threatening condition similar to severe bacterial pneumonia. Despite adequate intensive care, this infection progresses to acute respiratory distress syndrome and causes permanent lung damage in some patients. In this study, we analyzed clinical features and long-term follow-up clinical data of this infection in children. Methods : Forty-seven cases of inpatients were diagnosed as adenoviral respiratory tract infection by viral culture of nasal aspirates or histopathological diagnosis at Samsung Medical Center during the period from February 1995 to July 1998. We reviewed medical records retrospectively. Results : During this study, 1301 cases of acute respiratory tract infection were investigated, of which 47 cases were confirmed as adenoviral infection. Age ranged from 2 months to 6 years. Initial symptoms were productive cough(100%), fever(91%), dyspnea(62%), diarrhea(40%), and conjunctival injection(30%). Thirty-nine cases(83%) were pneumonia and 7 cases(15%) were bronchiolitis. The radiologic findings were pneumonic consolidation(60%), effusion(36%), infiltration(19 %), and atelectasis(13%). Five cases developed acute respiratory distress syndrome and 3 cases expired. In 31 cases of recovered patient, follow-up evaluation was done at a minimum of 3 months(mean duration 9.9■9.3 months). Under the follow-up evaluation, 13 patients(42%) showed physical and radiologic findings that consisted with bronchiolitis obliterans or bronchiectasis. Conclusion : Because of severe clinical manifestations and pulmonary complications, early diagnosis, adequate management, and long-term follow-up are needed for adenoviral respiratory tract infection. 목 적 : 소아에서의 아데노 바이러스에 의한 호흡기 감염은 세균성 폐렴과 유사한 임상 증상을 보일 수 있고 영구적 폐 손상을 남길 수 있는 것으로 알려져 있다. 본 연구에서는 아데노 바이러스 감염의 특징적 임상 양상과 치료후 후유증에 대한 추적 관찰 결과를 분석 하고자 하였다.방 법 : 1996년 2월부터 1998년 7월까지 호흡기 증상으로 입원한 환아 중 비인두 흡입물의 바이러스 배양에 의해 확진돤 45명과 1995년 부검상 확진된 2명의 임상 증상, 이학적 소견, 방사선 소견, 퇴원 후 추적관찰 결과를 의무 기록을 중심으로 분석하였다.

굴곡성 기관지경으로 치료 후 호전된 2개월 영아에서의 흡인성 폐렴

조영재,함세창,김우경,김영균,박용원,이혜경 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

The flexible bronchoscopy is not frequently used in children as in adults due to many causes. However the role of bronchoscopy in children is important in respect of diagnosis and treatment. We have done with flexible bronchoscopy for the purpose of diagnosis and treatment in a two-month-old infant with pneumonia and atelectasis. The lipid-laden alveolar macrophage(LLAM) index was 227/400. We thought the aspiration pneumonia of the patient resulted from his mother's abnormal feeding posture. After the bronchoscopy and washing, the radiologic findings and clinical symptoms were improved. We recommended the feeding position to the patient's mother and he has been well-being state afterwards.

성장기 결핵의 종류별 임상증상

이상일,함세창 中央醫學社 1999 中央醫學 Vol.64 No.3

소아에서 결핵성 중이염 1례

김은아,함세창,김영균,박용원,강윤경,Kim, Eun Ah,Ham, Se Chang,Kim, Young Kyoun,Park, Yong Won,Kang, Yun Kyung 대한소아감염학회 2002 Pediatric Infection and Vaccine Vol.9 No.1

결핵성 중이염은 매우 드문 질환이나 최근 결핵의 유병률이 증가하는 추세이므로 장기간의 항생제 치료에도 반응하지 않는 만성 중이염의 경우 결핵성 중이염의 가능성을 염두에 두어 감별진단 하여야 한다. 이런 관심은 조기 진단과 이에 따른 적절한 치료를 하게 되어 고막 파열, 청력 소실 및 안면신경마비와 같은 중한 합병증을 줄일 수 있을 것이다. Tuberculous otitis media is a very rare disease in extrapulmonary tuberculosis and in chronic otitis media nowadays. The characteristic signs seem to have altered from the past ones. And the suspicion index is very low that there is often a considerable delay prior to diagnosis. This might result in irreversible complications such as hearing loss, facial nerve paralysis and labyrinthitis. It is difficult to be defined by culture, so many patients with tuberculous otitis media are subjected to have surgery without a correct etiologic diagnosis. Therefore bacteriologic study of secretion and pathologic examinations of biopsied tissue are mandatory. We report one year and 11 months old boy with tuberculous otitis media having painful otorrhea and perforated tympanic membrane diagnosed by histologic finding and polymerase chain reaction(PCR). And we would like to emphasize the fact that tuberculous otitis media must be considered in the differential diagnosis of persistent suppurative otitis media despite appropriate antibiotic therapy considering the increasing tendency in incidence of Tuberculosis in Korea these days.

간질성 폐질환에 속하는 만성 영아 폐렴 1례

장현오,함세창,김영균,오세욱,박용원 대한소아청소년과학회 2001 Clinical and Experimental Pediatrics (CEP) Vol.44 No.9

Ramsay-Hunt 증후군 1례

정옥자,오세욱,함세창,박용원 대한소아청소년과학회 2000 Clinical and Experimental Pediatrics (CEP) Vol.43 No.12

Ramsay Hunt Syndrome was initially described by Ramsay Hunt in 1907 as herpes zoster of the geniculate ganglion. The frequency of RHS in patients with herpes zoster has been calculated to be about 1%. RHS affects mostly adults; however a small number of children with herpes zoster oticus have been reported. We describe a case of RHS in a healthy 39/12-year-old boy. A complete peripheral facial palsy on the left side was noted as well as vesicles of herpes zoster type on the pinna of the same side. The analysis of sera confirmed the clinical diagnosis of RHS with a positive IgG-ELISA antibody titier. Treatment of acyclovir was tried for 7 days, starting 2 days after facial palsy was objerved. In addition, oral prednisolon, divided into two doses per day, was administered for 5 days and then tapered to zero over the following 10 days. Complete recovery observed after 1 month. Ramsay-Hunt 증후군은 varicella zoster virus가 재활성화로 인한 일종의 슬신경절염을 유발하여 안면마비를 초래하는 질환이다. 진단은 임상 양상과 혈청학적 검사에 의존하며 치료는 Acyclovir를 주축으로 하여 prednisolon을 겸용하는 것이 도움이 된다.전체 대상포진 중 약 1%에서 나타나며 소아에서 발병한 예는 국내에서 보고된 바가 없으며 국외에서도 소수의 예만이 있을 뿐이다. 저자들은 안면 마비를 주소로 내원한 3년 9개월 된 남아에서 Ramsay-Hunt 증후군을 진단하고 acyclovir 및 prednisolon으로 치료하여 한달간 경과 관찰 후 완전한 회복을 보인 RHS 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

성인에서의 심실중격결손증에 대한 임상적 고찰

정옥자,김영균,함세창,오세욱,박용원,이홍섭 인제대학교 백병원 2001 仁濟醫學 Vol.22 No.2

Objectives: The aims of this study were to establish the natural courses and the pre- and post-operative complications of ventricular septal defect(VSD) in adult life. Materials & Methods: This study showed clinical results of 26 patients aged 20 years or older undergoing surgical repair of isolated VSD at Seoul Paik hospital during the period from Feb. 1989 to Dec. 2000. The data were analyzed retrospectively as to clinical profiles, data of cardiac catheterization, associated cardiac findings, operative methods, postoperative complications and mortalities. Results: The incidences of perimembranous(PM) VSD and subarterial(SA) VSD were 15 cases and 11 cases respectively. Data of preoperative cardiac catheterization showed mean values of Qp/Qs 2.34±1.12 in PM VSD and 1.26±0.09 in SA VSD. Mean pulmonary arterial pressure of PM VSD(49.9±25.5mmHg) was also higher than that of SA VSD(24.0±3.3). Aortic valve prolapses(AVP) and aortic insufficiencies (AI) were observed in 90.9% and 45.5% among SA VSD patients. As operative methods, patch closures were done mainly. We had good operative results without mortalities. Conclusions: The incidence of SA VSD in adult was relatively high compared to that in childhood. Corrective surgery in adult VSDs showed good operative results, so should be done immediately to prevent further damages to heart.

미숙아 동맥관 개존증에서 인도메타신 정맥 투여의 치료 성적에 대한 분석

이미경,김영균,함세창,오세욱,박용원 인제대학교 백병원 2001 仁濟醫學 Vol.22 No.2

Objective: The aims of this study were to determine the response of patent ductus arteriosus(PDA) and side effects to intravenous indomethacin therapy. Methods and Materials: From January 1999 to December 2000, 24 preterm infants diagnosed as significant PDA based on clinical and echocardiographic findings in NICU at Seoul Paik Hospital were analysed retrospectively for clinical effects and complications of intravenous indomethacin therapy. Results: The PDA was closed in 12(50%) and constricted in 10(42%) among total patients initially. Only one of 10 constricted infants was reopened. Second courses of indomethacin therapy were repeated in three patients showing poor responses, resulting in 67%(2/3) of PDA closure rate. Eventually, indomethacin therapy was successful in 22(92%) neonates, except 2 patients(8.3%) requiring PDA ligation. The side effects of indomethacin were transient hyponatremia(62.5%) and oliguria(4.2%). Total mortality rate was 12.5%(3/24), and only 1 case with pulmonary hemorrhage seemed to be possibly related to indomethacin therapy. Conclusions: The results of our study confirm that a significantly high PDA closure rate can be achieved by intravenous indomethacin administration. We conclude that intravenous indomethacin therapy can be the first method of treatment in premature infants with PDA, despite the transient renal side effects.

소아 갑상선종대에 관한 임상적 고찰

김수영,오세욱,함세창 釜山醫師會 1990 釜山醫師會誌 Vol.26 No.2

토끼에서 허혈성 급성 신부전에 대한 베라파밀의 보호효과

김용근,김수영,함세창,유황재 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.4

This study was undertaken to determine whether verapamil protects renal function in rabbits with ischemic acute renal failure. Renal ischemia was induced by clamping bilateral renal arteries for 60 min. One group received intravenously an infusion of verapamil(lmg/kg) for 30 min prior to initiation of renal artery clamping and the other group received equal volume of saline. Renal blood flow was measured with flowmeter before(basal) and 24 hr after ischemia. Serum creatinine level increased 24 hr after ischemia and remained high to 72 hr. When verapamil was pretreated, the level 48 and 72 hr after ischemia was significantly decreased compared with saline insusion. Urine flow was markedly decreased 24 hr after ischemia and remained depressed to 72 hr, but it was significantly increased 72 hr after ischemia in verapamil-pretreatment animals as compared with the saline-infusion animals. GFR were markedly reduced 24 hr after ischemia and remained depressed to 72 hr, which was significantly prevented by verapamil pretreatment. Ischemia caused a significant increase in FE_Na and a reduction in U_osm, and T^c_H2O, indicating impairment in urine concentrating ability of tubules, and the impairment was significantly attenuated by verapamil. The uptake of p-aminohippurate in cortical slices was depressed by ischemia, which was significantly prevented by verapamil pretreatment. In salineinfusion animals, renal blood flow was not significantly different between the basal value and that after 24 hr of reflow. Renal blood flow was not significantly altered by verapamil pretreatment. Anoxia/reoxygenation injury in the control renal slices was not significantly prevented by Ca^2+ channel blockers. These results suggest that verapamil exerts a protective effect in ichemic acute renal failure, and the beneficial effects may be attributed to effects other than vasodilation. These data also indicate that a reduction in GFR following ischemia does not result from change in renal blood flow