정상아에서 Lymphoma로 혼동된 Cryptococcal Lymphadenitis 1례

김보미,민기식,김종완,김광남,유기양,Kim, Bo Mi,Min, Ki Sik,Kim, Jong Wan,Kim, Kwang Nam,Ryoo, Ki Yang 대한소아감염학회 1996 Pediatric Infection and Vaccine Vol.3 No.2

Cryptococcosis is a rare in normal child and the majority of cases usually occur in patients with defective cell-mediated immunity. Infection is acquired by inhalation of organisms from the environment and disseminated via the blood stream to any organ of the body. We experienced a 7 year old girl who presented with fever, both cervical lymphadenopathy, hepatomegaly under the impression of lymphoma. However lymph node biopsy revealed cryptococcal budding and culture of lymph nodes yielded cryptococcus neoformans. The radiologic finding showed huge, multiple cervical lymph node enlargement spreading to mediastinum and abdomen. The immune fuction in term of T cell, B cell, serum immunoglobulin, complement and neutrophil function tests was normal. The patient was treated with amphotericin B and flucytosine for 6 weeks and responded to the treatment well. We report this case with brief review of the related literatures.

3회 재발한 폐렴 구균성 뇌막염 1례

최승은,민기식,김종완,김광남,유기양,Choi, Seung Eun,Min, Ki Sik,Kim, Jong Wan,Kim, Kwang Nam,Ryoo, Ki Yang 대한소아감염학회 1996 Pediatric Infection and Vaccine Vol.3 No.1

Streptococcal pneumoniae is the second most coomon cause of meningitis in infancy and a major respiratory pathogen. It is the one of the most common cause of acquired pneumonia and otitis media in childhood. Intracranial extesion of acute otitis media occur somewhat more often from poorly pneumatized than from well-pneumatized temporal bones and in ears with a history of previous attacks of otitis media. We experienced a case of pneumococcal meningitis with 3 time recurrences in a 6 year-old male patient who had hospitalized with high fever, headache, vomiting and stupor mental state. He was diagnosed as CSF study and brain CT. Brain CT showed poorly pneumatized right mastoid region of temporal bone at that time. We report a case of pneumococcal meningitis with 3 time recurrences due to poorly pnematized mastoid region of temporal bone. A review of literatures was also presented briefly.

호중구 감소된 급성 림프구성 백혈병환아에서 발생한 Pneumocystis carinii 폐렴 1례

최영환,민기식,김종완,김광남,유기양,Choi, Young Hwan,Min, Ki Sik,Kim, Jong Wan,Kim, Kwang Nam,Ryoo, Ki Yang 대한소아감염학회 1997 Pediatric Infection and Vaccine Vol.4 No.1

Pneumocystis carinii pneumonia mainly occurs in immunocompromised patients and it is also known of major cause of death in children with acute lymphoblastic leukemia. After consolidation chemotherapy, acute lymphoblastic leukemia children is developed Pneumocystis carinii pneumonia frequently no an opportunistic infection but there were no controlled studies which have been performed to evaluate the usefulness of corticosteroid in Pneumocystis carinii pneumonia with acute lymphoblastic leukemia. We experienced a case of Pneumocystis carinii pneumonia in acute lymphoblastic leukemia with febrile neutropenic 6 years old girl. She was treated with trimethoprim-sulfamethoxazole and prednisone. We report this case with brief review of related literature.

경련환아에서 자기공명영상의 유용성

박선영(Sun Young Park),민기식(Ki sik Min),김종완(Jong Wan Kim),김광남(Kwang Nam Kim),유기양(Ki Yang Ryoo) 대한소아신경학회 1995 대한소아신경학회지 Vol.3 No.1

연구배경 : 경련성 질환 환아의 자기공명영상을 분석하여 그 유용성에 대해 고찰하기 위해 본 연구를 시행하였다. 방 법 : 1991년 5월부터 1994년 6월까지 경련을 주소로 강동성심병원 소아과에 내원하여 자기공명영상과 뇌파검사를 실시하였던 94례를 대상으로 자기공명영상 이상소견 및 이상소견 발견율, 연령과 이상소견과의 상관관계 등을 조사하였으며 뇌파검사와 비교분석하였다. 결 과 : 1. 자기공명영상을 시행한 94례중 34례(36%)에서 이상소견이 발견되었고 뇌파검사는 52례(55%)에서 발견되었다. 뇌파검사에서는 부분 발작의 경우가 전신 발작의 경우보다 이상소견 발견율이 높았으나, 자기공명영상의 경우는 두 경련 형태간에 통계적으로 유의한 차이가 없었다. 2. 자기공명영상 이상소견 34례중 뇌낭종이 9례(26.5%)로 가장 많았고, 뇌위축, 선천성 기형과 백질 병변의 순이었다. 3. 각 연령에 따른 자기공명영상과 뇌파검사의 이상소견 발견율은 1개월 미만에서 각각 67%, 67%로서 가장 높았다. 결 론 : 경련환아에서 자기공명영상은 부분 발작 환아 및 전신 발작 환아 모두에게 유용한 검사라고 사료된다. Background : This study was performed to determine the efficacy of MRI in pediatric seizure disorder. Method : Ninety-four pediatric patients with seizure between May 1991 and June 1994 had performed both MRI study and EEG. We observed the data about the positive MIR findings and the relation of positive MRI and EEG from the aspect of both age and seizure type. Result : 1. In ninety-four patients, MRI was positive in 34(36%). EEG was positive in 52(55%). EEG was more sensitive to detect abnormal findings in partial seizure rather than generalized seizure. but there was no significant difference in statistics between two seizure types when we performed MRI. 2. Abnormalities(34) included benign cystic lesion(9),cerebral atrophy(5),congenital structural anomaly(4), white matter lesion(4) and miscellaneous(12). 3. The frequency of the abnormalities in both MRI and EEG was highest in neonatal period. Conclusion : MRI is the efficacious procedure in evaluating various seizure disorder of pediatric patients.

동일 열성질환에서 반복성 열성경련의 예방을 위한 Diazepam의 효과

조도준(Do Jun Cho),민기식(Ki Sik Min ),김종완(Jong Wan Kim),김광남(Kwang Nam Kim),유기양(Ki Yang Ryoo) 대한소아신경학회 1993 대한소아신경학회지 Vol.1 No.2

The efficacy of short-term diazepam prophylaxis in repeated febrile seizures was evaluated in a prospective controlled study. A total 172 consecutive children admitted with their febrile seizure were participated in our study from May,1991 to June,1992. The children of control group were admitted with their febrile seizure from January,1987 to December,1990. Intravenous Diazepam(0.1mg/kg) is administered to patients with febrile seizures at admission. And oral Diazepam(0.5mg/kg/day) is administered at first hospitalization day. At second hospitalization day, consecutive oral Diazepam (0.6 mg/kg/day) is administered. The results were as follows: 1) The incidence of repeated febrile seizure was 8.1% in study group and 17.0%in control group. 2) In hospital, repeated febrile convulsion was 0.6% in study group and 4.3% in control group. 3) The repeat rate of febrile seizure with fever less than 39℃ was 6.3% in study group and 20.5% in control group. 4) The repeat rate of febrile seizure with serum sodium concentration under 135mEq/L was 10.9% in study group and 47.4% in control group. 5) There was no serious side effects of diazepam.

급성 위장관염에 동반된 초발 비열성 경련에 대한 임상적 연구

김보미(Bo Mi Kim),김기식(Ki Sik Min),김종완(Jong Wan Kim),김광남(Kwang Nam Kim),유기양(Ki Yang Ryoo) 대한소아신경학회 1995 대한소아신경학회지 Vol.3 No.1

배경 : 저혈당이나 전해질 이상 등 대사적 원인을 동반하지 않은 경한 위장관염 증상을 가진 환아에서 일어난 초발 비열성 경련의 임상적 특징 빛 신경학적 예후에 관하여 살펴보고, 이러한 비열성 경련의 원인으로 Rotavirus가 관여함을 알아보기 위하여 본 연구를 시작하였다. 대상 및 방법 : 1989년 1월 1일에서 1993년 12월 31일까지 초발 비열성 경련으로 강동성심병원에 입원한 환아 89례 중, 저혈당이나 전해질 이상을 동반하지 않은 경한 설사 증상이 있는 환아 24례(27.0%)를 대상으로 이들의 성별, 연령별, 계절별 분포 및 경련 형태, 경련 양상에 관해 살펴보고, Rotavirus에 대한 검사와 함께 뇌파 검사, 뇌단층 촬영 및 자기 공명 영상법을 시행하였다. 환아들은 6개월에서 5년 6개월간 외래 및 가정연락으로 추적 관찰을 시행하였다. 결과 : 1. 분포 : 24례의 대상 환아 중 성별은 남아가 11명(45.8%) 여아가 13명(54.2%)이었고, 연령 분포는 12개월 미만이 1명(4.2%), 12개월에서 23개월 사이가 20명(83.3%), 24개월에서 35개월 사이가 3명(12.5%)이었으며, 36개월 이상은 없었다. 2. 경련 양상: 전신 강직-간대 발작이 15명(62.5%)으로 가장 많았고, 전신 강직 발작이 7명(29.2%), 부분발작이 2명(8.3%) 순이었다. 경련 기간은 5분 이내가 20명(83.4%), 5분에서 14분 사이가 2명(8.3%)이었으며, 30분 이상은 없었다. 3. 계절 : 11월이 8명(33.3%)으로 가장 많았고, 12월이 6명, 3월이 3명이었으며, 1월 8월이 각 2명씩, 5월, 7월, 9월이 각 1명씩 이었다. 4. Rotavirus 양성률 : Rotavirus 검사는 12례에서 Rotazyme 법으로 시행하였는데, 이중 10명(83.3%)에서 양성 반응을 보였고 2명 (16.7%)은 음성이었다. 5. 검사 : 뇌파 검사는 20례(83.3%)에서 정상 소견을 보였으며, 뇌단층 촬영은 6례에서 시행하였는데 모두 정상 소견을 보였다. 6. 추적 관찰 : 6개월에서 5년 6개월간의 추적 관찰에서 재발을 일으키거나 신경학적인 후유증을 남긴 경우는 없었다. 결론 : 급성 위장관염과 관련된 비열성 경련은 주로 1세에서 3세 사이에서 늦가을과 겨울철에 많이 호발하고, 대부분에서 전신 강직-간대 발작 양상을 나타내며, 뇌파 검사, 뇌단층 촬영, 전해질 검사에서 특이한 이상 소견을 보이지 않았다. 경련은 비교적 잘 조절되고, 간질이나 다른 신경학적 후유증은 일으키지 않는 양성 경과를 취하는 것으로 보여지며, 그 원인으로 Rotavirus가 관계하는 것으로 생각되어지나 그 기전은 아직까지 명확하게 밝혀지지 않고 있다. Background : Afebrile seizures are sometimes found in patients with mild gastroenteritis. This study was performed to characterize the clinical features and the neurolgic outcome and to evaluated their relationship between afebrile seizure and rotavirus gastroenteritis. Method : we reviewed retrospectively the medical records of 24 patients. with first afebrile seizure and mild diarrhea, who were admitted to the department of pediatics, Kangdong Sacred Heart Hospital, Hallym University, during 5 years from Jan. 1989 to Dec. 1993. Results : 1) Most patients (95.8%) were from 12 to 36 months of age. 2) 62.5% of the seizures were generalized tonic-clonic type and duration of each seizure was mostly within 5 minutes. 3) In the monthly distribution, 66.7% were found between November and January. 4) 10 of 12 cases (83.3%) were Rotazyme positive. 5) 20 of 24 cases (83.3%) showed normal electroencephalographic patterns and 6 cases were checked brain CT, there were no abnormal finding. 6) The follow up results were that none had recurrence or neurologic sequelae. Conclusion : we suggest that Rotavirus is suspected of being one of the causative agents of afebrile seizures with mild diarrhea. and that seizures were well controlled and had favorable outcome.

Herpes Simplex Encephalitis 3례

최승은(Seung Eun Choi),윤진희(Jin Hee Yoon),민기식(Ki Sik Min),김종완(Jong Wan Kim),김광남(Kwang Nam Kim),유기양(Ki Yang Ryoo) 대한소아신경학회 1994 대한소아신경학회지 Vol.2 No.1

The incidence of neonatal herpes simplex infection appears to have increased pari passu with the increase in incidence of genital herpes simplex infection in adults. The authors experienced three cases of herpes simplex encephalitis. Both the EEG and brain MRI showed striking and characteristic changes in the investigation of the neonate suspected of having herpes simples virus encephalitis in these cases. A brief review of related literatures is included in this report.

초기 신생아 황달 발생 예측의 선별검사로서 경피적 빌리루빈 측정법이 유용성

최영환 ( Young Hwan Choi ),차재국 ( Jae Kook Cha ),김종완 ( Jong Wan Kim ),유기양 ( Ki Yang Ryoo ) 대한주산의학회 1999 Perinatology Vol.10 No.1

뇌성 마비 환아에서 뇌 자기공명 영상 소견

유창현(Chang Hyun Yoo),윤대영(Dae Young Yoon),조현상(Hyun Sang Cho),민기식(Ki Sik Min),김종완(Jong Wan Kim),유기양(Ki Yang Ryoo) 대한소아신경학회 1999 대한소아신경학회지 Vol.6 No.2

목적: 뇌성마비 환아의 MRI를 후향적으로 분석하여, 뇌손상 평가지 MRI의 역할, 임신 주수에 따른 MRI 소견의 차이를 알아보았다. 방법: 1994년 1월부터 1998년 7월까지 강동성심병원에서 뇌성마비로 진단받은 66명(만삭아 37명 미숙아 29명)의 MRI를 미숙아군과 만삭아군으로 나누어 비교하였다. 결과: 미숙아군 29례에서 13례가 저산소성 허혈성 뇌손상의 소견을 보였는데 PVL이 12례(41.3%)로 가장 많았고 신경 세로 이주 장애가 6례(20.8%), 기타 선천성 뇌기형 5례(17%), multifocal ischemic necrosis 1례(3.4%), 정상 소견이 5례(17%)에서 관찰되었다. 만삭아군 37례에서 22례가 저산소성 허열성 뇌손상의 소견을 보였으며 selective neuronal necrosis 11례(29.7%), PVL 4례(10.8%), focal and multifocal ischemic necrosis 4례(10.8%), 대리석 상태 3례(8.1%), 신경 세포 이주 장애 4례(10.8%), 기타 선천성 뇌기형 5례(13.5%), 정상 소견이 6례(16.2%)에서 관찰되었다. 결론: MRI를 통해서 뇌성 마비 환아에서 다양한 병변을 관찰할 수 있으며 저산소성 허혈성 뇌손상은 미숙아군과 만삭아군에서 유의한 차이를 보였다. 미숙아군에서는 PVL이 흔하고 만삭아군에서는 selective neuronal necrosis가 통계적으로 많았다. Purpose: We used MRI to retrospectively analyze the brain of patients suffering from cerebral palsy. Our aim is to determine MRI's role in the assessment of brain damage, the relationship of gestational age. Methods: A total of 66 patients(29 preterm group and 37 term group), who visited Kang-Dong Sacred Heart Hospital from January, 1994 to July, 1998, where enrolled in study. Results: Among the 29 in the preterm group, 13 patients showed MR images of hypoxic ischemic injury in which periventricular leukomalacia(PVI) and multifocal ischemic necrosis in 12(41.3%) and 1(3.4%) respectively. Neuronal MR images 5(17%) in this preterm group. Among the 37 in the term group, 22 patients showed MR images of hypoxic ischemic injury in which selective neuronal necrosis were 11(29.7%), PVL 4(10.8%), focal and multifocal ischemic necrosis 4(10.8%) and status marmoratus 3(8.1%). Meuronal migration disorders were 4(10.8%), other congenital malformations 5(13.5%) normal MR images 6(16.2%) in the term group. Conclusion: MRI provided useful information in a majority of children with cerebral palsy. Hypoxic ischemic injury was significantly different in preterm and term groups. PVL was frequent in the preterm group and selective neuronal necrosis was statistically common in the term group.

상부위장관증상을 주소로 하는 소아의 위내시경 검사소견

선덕재(Duk Jae Shun),김우요(Woo Yo Kim),황영희(Yeong Hee Hwang),임규성(Kyu Sung Rim),이명희(Myung Hee Lee),박두희(Doo Hee Park),정선문(Sun Moon Jung),유기양(Ki Yang Ryoo) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

we observed 283 cases of pediatric patients who complain of upper gastrointestinal symptoms for average more than a month by gastrofiberscopes in internal medicine and pediatric department of Kangnam Sacred Heart Hospital, Hallym College, from January 1981 to December l985 and following results were obtained. 1) The male to female retio was about 1.2:1. The frequency of age distribution inorder is 67.5% in puberty, 27.2% in late childhood, and 5.3% in early childhood. 2) There was no relationship between upper gastrointestinal symptoms and each age groups. 3) The diseas classification in order of frequency were gastroenteritis (51.6%), functional gastrointestinal disturbance(23.0%), peptic ulcer(12.7%), and hepatitis(3.2%). 4) The endoscopic abnormalities were noted 80.%, in early childhood, 68.8%.: in late childhood, and 76.4% in puberty. 5) Gastrofiberscopy in considered to be simple, safe and highly valuable tool making diagnosis of upper gastrointestinal disease.