주의력결핍 과잉운동장애 소아에서 배뇨장애와 변비의 유병률

김준영,이은섭,방지석,오연정,이용주,성태정,이건희,이정원,Kim, Joon Young,Lee, Eun Seob,Bang, Ji Seok,Oh, Yeon Joung,Lee, Yong Ju,Sung, Tae-Jung,Lee, Kon-Hee,Lee, Jung Won 대한소아신장학회 2014 Childhood kidney diseases Vol.18 No.2

목적: 주의력결핍 과잉운동장애(ADHD)는 소아에서 3-5%의 유병률을 보이며 전두엽의 억제기전 저하와 대뇌의 카테콜라민 대사이상이 관련된다고 알려져 있다. ADHD 환아에서 야뇨증을 비롯한 다양한 하부요로계 증상을 동반한다는 보고가 있지만 국내에서는 ADHD 환아들에 대한 보고가 없기에 저자들은 ADHD 환아에서 배뇨증상을 알아보기 위해 본 연구를 시행하였다. 방법: 2009년 10월부터 2011년 3월까지 DSM-IV 진단기준에 근거하여 ADHD로 진단받은 33명의 환아들과 같은 기간 동안 신경계 질환이나 요로계 질환 없이 상기도 감염으로 외래를 내원한 환아 30명을 대상으로 배뇨와 배변에 대한 설문지를 시행하였다. 결과: ADHD 환자군의 평균 연령은 $9.09{\pm}2.8$세(남 28: 여 5) 이었고, 대조군의 평균 연령은 $8.58{\pm}3.1$ (남 20: 여 10) 이었다. ADHD 환아군에서 대조군에 비해 요절박(P=0.017), 절박 요실금(P=0.033), 변비(P=0.045)의 유병률이 대조군에 비해 유의하게 높았고, 복압배뇨, 간헐뇨, 배뇨지연 행동에는 두 군간에 유의한 차이가 없었다. 야뇨증은 ADHD 환아군에서 12.1% (4/33)로 대조군의 0%에 비해 많았지만 통계학적인 유의성은 없었다. 결론: ADHD 환아는 대조군에 비해 요절박, 절박 요실금과 변비의 유병률이 유의하게 높았다. Purpose: Attention deficit hyperactivity disorder (ADHD) has been associated with impairments in frontal inhibitory function and the catecholaminergic system. ADHD is diagnosed in 3-5% of children. Children with ADHD seem develop various forms of urinary problems such as nocturnal enuresis, dysfunctional voiding, and diurnal incontinence. However, no data exist to confirm the presence of these problems in Korean children with ADHD. We investigated the clinical findings of voiding dysfunction in children with ADHD. Methods: Between October 2009 and March 2011, a total of 63 children (33 with ADHD, 30 with an upper respiratory infection, as a control group) were enrolled. ADHD was diagnosed using the diagnostic and statistical manual of mental disorders (DSM)-IV criteria. A comprehensive survey of voiding and defecation was administered. Results: The patient group included 28 boys and 5 girls; the control group comprised 20 boys and 10 girls. The mean age was $9.09{\pm}2.8$ years in the ADHD group and $8.58{\pm}3.1$ years in the control group. Children with ADHD had a statistically significantly higher incidence of urgency (P =0.017), urge incontinence (P =0.033), and constipation (P =0.045). There was no significant difference in the incidence of straining, intermittency, holding maneuvers, or nocturnal enuresis. Conclusion: Children with ADHD in Korea have significantly higher rates of urgency, urge incontinence, and constipation than those without ADHD.

학령전기 만성 기침 환아에서 알레르기 감작의 위험 요인

이은섭 ( Eun Seob Lee ),방지석 ( Ji Seok Bang ),오연정 ( Yeon Joung Oh ),이정원 ( Jung Won Lee ),성태정 ( Tae Jung Sung ),이용주 ( Yong Ju Lee ),이건희 ( Kon Hee Lee ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.2

Purpose: Chronic cough is one of the major symptoms of asthma and allergic sensitization and may appear prior to the onset of asthma. The object of this study was to investigate the risk of allergic sensitization in preschool children with chronic cough. Methods: We reviewed the medical records of 99 preschool children presenting with chronic cough but not with allergic rhinitis, atopic dermatitis, recurrent wheezing, or lower respiratory tract infection between November 2011 and July 2013. Results: Fifty-four children (55%) were sensitized at least one of the following inhalant allergens: Dermatophagoides pteronyssinus, Dermatophagoides farinae, cockroach, Alternaria alternata, dog dander, and cat epithelium. Children with allergic sensitization had a higher blood total IgE levels transformed by common logarithm (1.9±0.6 IU/mL vs. 1.3±0.5 IU/mL, P<0.001) and eosinophils (3.7%±2.5% vs. 2.7%±2.0%, P=0.043), more frequent parental history of allergy (68% vs. 48%, P=0.044) and less frequent history of breast milk feeding (68% vs. 86%, P=0.041) than those without. Conclusion: These results suggest that the ratio of allergic sensitization may be 50% or more in preschool children with chronic cough and that parental history of allergy and formula milk feeding may be associated with allergic sensitization. (Allergy Asthma Respir Dis 2015;3:105-108)

임신 중 항고혈압제 및 황산마그네슘을 투여 받은 고혈압 장애를 가진 산모에서 태어난 미숙아의 임상 예후

서봉설 ( Bong Sul Suh ),고근혁 ( Keun Hyeok Ko ),방지석 ( Ji Seok Bang ),오연정 ( Yeon Joung Oh ),이정원 ( Yong Ju Lee ),이용주 ( Jung Won Lee ),이건희 ( Kon Hee Lee ),성태정 ( Tae Jung Sung ) 대한주산의학회 2015 Perinatology Vol.26 No.3

Purpose: Hypertensive disorders of pregnancy increase morbidity and mortality of fetus and neonates. Recently some studies revealed that antihypertensive agents affected the neonatal outcomes. The aim of this study was to investigate the prognosis of preterm infants delivered from the mothers with hypertensive disorders who were treated with antihypertensive agents and magnesium sulfate. Methods: This retrospective study was conducted on preterm infants who were delivered from normotensive mother (control, n=436) and antihypertensive drugs +/- magnesium sulfate treated mother (study, n=150) between January 2009 and December 2013. Study group were divided into two groups based on whether they received antihypertensive drugs only (n=110) and additional magnesium sulfate (n=40). We compared the characteristics of mothers and neonatal outcomes. Results: Study group had shorter gestational age (32.2±3.5 weeks vs. 33.7±3.0 weeks, P=0.000) and lower birth weight (1,810.5 ± 689.2 g, 2,212.1 ± 604.9 g, P=0.000), and higher rate of small for gestational age infants (22% vs 11%, P=0.000). One minute and 5 minutes Apgar score were lower, but duration of hospital days, oxygen supplement and mechanical ventilation were longer in study group. Respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, intraventricular hemorrhage occurred more in study group than control. The group treated with magnesium sulfate together with antihypertensive agent had lower 1 minute and 5 minutes Apgar score than the group taken antihypertensive agent only. Conclusions: Mothers with hypertensive disorders have increased the risk of preterm delivery, low birth weight, and high neonatal morbidity rate. Therefore it is important to predict and manage possible complication. Moreover, if magnesium sulfate is taken, careful neonatal monitoring is needed because of possible low Apgar score.

편두통 유사 증상을 보인 갑상샘기능항진증 1례

양원준(Won Jun Yang),전상훈(Sang Hoon Chun),오연정(Yeon Joung Oh),이건희(Kon Hee Lee) 대한소아신경학회 2016 대한소아신경학회지 Vol.24 No.4

편두통은 소아청소년에서 흔한 질환으로 조기에 정확한 진단과 적절한 치료가 환자의 삶의 질을 높이는데 매우 중요하다. 정확한 진단을 위해서 두통의 2차적 원인을 감별해야 하는데, 매우 드문 질환이 원인인 경우는 어려움이 따른다. 최근 2차적 원인 중에서 갑상샘기능이상이 드물게 두통과 관련이 있다는 보고가 있다. 저자들은 갑상샘기능항진증으로 인하여 편두통 증상을 보인 환아 증례를 치험하였기에 보고한다. 15세 남아가 2주전부터 처음으로 시작된 주당 4회 정도의 심한 두통(7-8시각 아날로그 척도)을 호소하며 외래 통해 입원하였다. 두통의 통증 부위는 주로 앞이마 부위로 2-3시간 정도 지속되었으며 구역 증세도 동반하였다. 두통 동안에 30초 정도의 어지러움과 시야흐림 증상이 있었다. 생체 징후는 안정적이었으며 뇌자기공명영상 검사에서 특이소견 보이지 않았다. 말초혈액 검사에서 특이소견 보이지 않았으나 호르몬 검사에서 갑상샘 자극호르몬 수치가 0.076 μIU/mL로 증가되어 있었고, T3 >800 ng/dL, free T4 2.19 ng/dL로 증가되어 있었다. 갑상샘 초음파 검사에서 불균일한 저에코양상을 보였으며, 핵의학 검사에서는 양측 갑상샘 동위 원소 섭취율이 1.2%로 감소되어 있었다. 최초에 임상적으로 무조짐편두통을 의심하였으나, 갑상샘기능 항진증 진단 하에 methimazole(15 mg/day)로 치료를 시작하였다. 15일간 투약 후 두통증세 호전되었으며 갑상샘 호르몬 기능도 정상으로 돌아왔다. 소아두통환자에서 설명되는 않는 두통 설명되지 않는 두통 특히 만성 혹은 두통병력이 없는 환자가 갑자기 심한 두통을 호소하는 경우 등의 환자에서는 갑상샘 기능검사에 대한 검토도 필요할 것으로 생각된다. Migraine is a common neurological disorder that often presents severe headache pain with nausea, vomiting, or sensitivity to light or sound. Children and adolescents with migraine experience drastically impaired quality of life. Therefore early diagnosis and treatments of headache are necessary in addition to accurate differentiation of secondary causes of headache. There are some reports that thyroid dysfunction especially hyperthyroidism may be responsible for producing headache symptoms. We detail a case of 15-year-old boy who was admitted to our hospital due to recurrent episodes of severe headache accompanied by nausea, compatible with the criteria for migraine without aura in the ICHD 3-beta , but finally diagnosed as hyperthyroidism. We further discuss the implications of current research regarding the association between thyroid dysfunction and headache. It is necessary to check the thyroid function tests in the in pediatric patients experiencing unusual headache symptoms.

산전검사를 시행하지 않은 산모에서 태어난 신생아의단순 포진 바이러스 2형 뇌염 1례

이은섭 ( Eun Seob Lee ),김준영 ( Joon Young Kim ),이건희 ( Kon Hee Lee ),이정원 ( Jung Won Lee ),이용주 ( Yong Ju Lee ),오연정 ( Yeon Joung Oh ),방지석 ( Ji Seok Bang ),성태정 ( Tae-jung Sung ) 대한주산의학회 2014 Perinatology Vol.25 No.3

Neonatal herpes simplex virus (HSV) encephalitis is a rare disease nowadays because of prenatal screening test and management. It shows progressive central nervous system manifestations affecting predominantly temporal and frontal lobes. Early diagnosis of HSV encephalitis is important since even with the early initiation of high-dose intravenous acyclovir therapy, it results in serious morbidity among survivors. A 14-day-old neonate with fever and poor oral intake was admitted via emergency department. The next day she had seizures and the brain was damaged with permanent sequelae despite of early administration of intravenous acyclovir on day 2 of admission. We report a serious case of HSV encephalitis diagnosed as type 2 HSV by PCR and culture of a newborn who was delivered by a mother without proper prenatal screening test.