Patterns of ischemic injury on brain images in neonatal group B Streptococcal meningitis

최서열,김종완,고지원,이영석,장영표 대한소아청소년과학회 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.8

Purpose: This study investigated patterns of ischemic injury observed in brain images from patients with neonatal group B Streptococcal (GBS) meningitis. Methods: Clinical findings and brain images from eight term or near-term newborn infants with GBS meningitis were reviewed. Results: GBS meningitis was confirmed in all 8 infants via cerebrospinal fluid (CSF) analysis, and patients tested positive for GBS in both blood and CSF cultures. Six infants (75.0%) showed early onset manifestation of the disease (<7 days); the remaining 2 (25.0%) showed late onset manifestation. In 6 infants (75%), cranial ultrasonography showed focal or diffuse echogenicity, suggesting hypoxic-ischemic injury in the basal ganglia, cerebral hemispheres, and periventricular or subcortical white matter; these findings are compatible with meningitis. Findings from magnetic resonance imaging (MRI) were compatible with bacterial meningitis, showing prominent leptomeningeal enhancement, a widening echogenic interhemisphere, and ventricular wall thickening in all infants. Restrictive ischemic lesions observed through diffusion-weighted imaging were evident in all eight infants. Patterns of ischemic injury as detected through MRI were subdivided into 3 groups: 3 infants (37.5%) predominantly showed multiple punctuate lesions in the basal ganglia, 2 infants (25.0%) showed focal or diffuse cerebral infarcts, and 3 infants (37.5%) predominantly showed focal subcortical or periventricular white matter lesions. Four infants (50%) showed significant developmental delay or cerebral palsy. Conclusion: Certain patterns of ischemic injury are commonly recognized in brain images from patients with neonatal GBS meningitis, and this ischemic complication may modify disease processes and contribute to poor neurologic outcomes.

다양한 임상경과를 보인 멜라스(MELAS, mitochondrial encephalopathy, lactic acidosis, and stroke-like episode) 증후군 2례

최서열,이승호,명나혜,이영석,유지숙,Choi, Seo Yeol,Lee, Seung-Ho,Myung, Na-Hye,Lee, Young-Seok,Yu, Jeesuk 대한유전성대사질환학회 2016 대한유전성대사질환학회지 Vol.16 No.2

멜라스 증후군은 사립체 질환 중의 하나로서, 증상발현 시기 및 임상 양상이 매우 다양하여 의심하지 않으면 진단이 늦어지는 경우가 있을 수 있다. 연구자들은 임상경과를 달리하는 두 증례를 경험하였기에 보고하는 바이다. 증례 1에서는 두통과 시야 흐림, 경련 등이, 증례 2에서는 성장장애, 난청, 시야 흐림, 경련 등이 초기 증상으로 나타났으며, 증례 1은 현재도 일상 생활이 가능한 정상적인 활동도를 보이는 반면에, 증례 2의 경우에는 심각한 뇌손상을 받은 후에 진단되어 예후가 불량하였다. 멜라스 증후군의 치료는 대증적으로 이루어지게 되며, 약물적인 치료 중 코엔자임 Q10, L-아르지닌 등을 사용하였을 때 성공적인 결과를 얻을 수 있다. 질환의 초기에는 비특이적인 경우가 많음으로 관심과 의심을 통하여 멜라스 증후군을 조기 진단하는 것이 매우 중요하다고 할 수 있으며, 조기 진단과 적절한 교육 및 지지적인 치료를 통해 임상경과를 좋게 만들 수 있도록 노력하는 것이 예후에 중요하다고 할 수 있겠다. Mitochondrial encephalopathy, lactic acidosis, and stroke-like episode (MELAS) syndrome is one of mitochondrial encephalopathy. As the early clinical manifestations can be variable, it is important to suspect the disease, especially in patients with multiple organ dysfunctions. A boy was diagnosed with epilepsy when he was 9 years old. Two years later, severe headache and blurred vision developed suddenly. On examination, left homonymous hemianopsia was detected with corresponding cerebral parenchymal lesions in right temporo-occipito-parietal areas. MELAS syndrome was confirmed by genetic test, which showed m.3243 A>G mitochondrial DNA mutation. Multivitamins including coenzyme Q10 were added to anticonvulsant. He experienced 4 more events of stroke-like episodes over 5 years, but he is able to perform normal daily activities. A 13-year-old boy was brought to the hospital due to suddenly developed respiratory arrest and asystole associated with pneumonia. Past medical history revealed that he had multiple medical problems such as epilepsy, failure-to-thrive, optic atrophy, and deafness. He has been on valproic acid as an anticonvulsant which was prescribed from local clinic. He recovered after the resuscitation, but his cognition and motor function were severely damaged. He became bed-ridden. He was diagnosed with MELAS syndrome by brain MRI, muscle biopsy, and clinical features. Genetic test did not reveal any mitochondrial gene mutation. Four years later, he expired due to suddenly developed severe metabolic acidosis combined with hyperglycemic hyperosmolar nonketotic coma. The clinical features of MELAS syndrome are variable. Early diagnosis before the presentation to the grave clinical course may be important for the better clinical outcome.

소아 장바이러스 뇌수막염의 임상적 특징 및 신경학적 합병증

최서열,이영석,유지숙 대한소아신경학회 2017 대한소아신경학회지 Vol.25 No.4

Purpose: To explore clinical features and neurologic complications of pediatric enteroviral meningitis, and to evaluate risk factors according to the presence of cerebrospinal fluid (CSF) pleocytosis and neurologic complications. Methods: Retrospective review of medical records of patients aged between 1 month and 18 years who were found positive for CSF enterovirus reverse transcription polymerase chain reaction in Dankook University Hospital from March 2009 to February 2015. Results: A total of 151 children was enrolled in the study. Ninety four patients were males and the age at diagnosis was 40.9±47.0 months. Most common season of admission was summer (n=99, 65.6%). Most frequent presenting symptom was fever followed by poor oral intake, decreased activity, and headache. Fifty five (36.4%) patients had no CSF pleocytosis. Complications were observed in 4 (2.6%). Mean blood white blood cell, CSF protein levels were higher, and CSF glucose levels were lower in group with pleocytosis (P<0.05). There were more seizure development and mental changes, higher peak body temperature, longer fever duration, and longer duration from symptom onset to CSF tapping in group with complications (P<0.05). All were boys and mean age at admission was younger in group with complications, without statistically significant difference. Conclusion: Relatively high proportion of children with enteroviral meningitis showed no pleocytosis. Complications such as meningoencephalitis, refractory status epilepticus, or recurrent seizure rarely occurred, although most had good clinical outcomes. 목적: 소아에서의 장바이러스 뇌수막염의 임상 특징 및 신경학적합병증을 알아보고, 뇌척수액 백혈구 증가증의 유무와 신경학적 합병증의 발생 유무에 따른 위험인자의 차이를 알아보고자 하였다. 방법: 2009년 3월부터 2015년 2월 사이에 단국대학교병원에 입원한 1개월에서 18세까지의 환아들 중 뇌척수액의 장바이러스 RT-PCR 에서 양성소견을 보인 환아들을 대상으로, 그 의무기록을 후향적으로 연구하였다. 결과: 총 151명이 본 연구에 포함되었다. 94명(62.3%)이 남아였으며, 진단 시 평균 나이는 40.9±47.0개월 이었다. 가장 흔한 입원 계절은 여름으로 나타났다(n=99. 65.6%). 입원 시 증상은 발열, 경구섭취감소, 활동 감소, 그리고 두통 순으로 많이 나타났다. 55명(36.4%)에서 뇌척수액 백혈구 증가증을 보이지 않았고, 신경학적 합병증은 4명(2.6%)에서 관찰되었다. 뇌척수액 백혈구 증가증을 보인 경우 혈액 백혈구 수와 뇌척수액 단백질은 더 높게, 뇌척수액 당 농도는 더 낮게 나타났다(P<0.05). 경련의 발생, 뇌 영상 검사 이상소견의 존재, 그리고진단 이후 발생한 신경발달 이상 등을 신경학적 합병증의 발생으로정의해 보았을 때, 신경학적 합병증을 보인 군에서 경련의 발생 및 의식변화가 더 많았고, 최고 체온이 더 높았으며, 총 발열 기간이 더 길었다(P<0.05). 신경학적 합병증을 보인 환아들은 모두 남아였으며 평균 입원 나이는 더 어렸지만, 통계적으로 유의하진 않았다. 결론: 장바이러스 뇌수막염이 진단된 환아들 중 3분의 1이 넘는 환아들에서 뇌척수액 백혈구 증가증이 동반되지 않았으며, 대부분은 예후가 좋았지만, 뇌전증 지속증, 의식변화를 보인 수막뇌염, 재발성 경련 등의 신경학적 합병증이 드물게 나타났다. 신경학적 합병증을 보인군에서 경련과 의식변화가 더 많았고, 총 발열기간이 더 길었으며, 최고 체온 및 뇌척수액 단백질과 백혈구의 수치가 더 높았다.

소아에서 치료 불응성 마이코플라스마 폐렴의 위험 인자에 대한 임상적 분석

최서열,서주희,이건송,최규태 대한 소아알레르기 호흡기학회 2018 Allergy Asthma & Respiratory Disease Vol.6 No.1

Purpose: Refractory Mycoplasma pneumonia (RMP) has been increasing not only in Korea but worldwide. We investigated the incidence of M. pneumonia resistant to macrolides and risk factors for RMP. Methods: From October 2015 to May 2016, 62 pediatric patients who were admitted due to pneumonia diagnosed on the basis of chest x-ray with respiratory symptoms and positive for M. pneumoniae in polymerase chain reaction with no evidence of other bacterial or viral infections were included. Sequence analysis of the 23S rRNA gene in M. pneumoniae was performed to identify macrolide resistance. Patients with congenital anomalies, history of pulmonary disease, and unclear information on antibiotic use were excluded. Results: Mutations in the 23S rRNA gene were detected in 50 of 62 patients (80.6%). Risk factors were analyzed in only 45 patients. The RMP group consisted of 26 patients (57.8%) who had fever lasting more than 5 days and deteriorating chest x-ray findings. The lactate dehydrogenase (LDH) and C-reactive protein (CRP) levels were significantly higher in the RMP group than in the non-RMP group (LDH: 300±79 U/L vs. 469±206 U/L, CRP: 4.9±4.3 mg/dL vs. 2.5±1.7 mg/dL; P=0.04 vs. P=0.026). In univariate analysis, the RMP group was significantly associated with 23S rRNA gene mutation, lobar pneumonia, and pleural effusion (odds ration [OR]: 10.8, 4.1, 5.3; P=0.004, P=0.036, P=0.046). The presence of macrolide resistance was found to be only a significant risk factor in logistic regression (OR; 8.827; 95% confidence interval, 1.376–56.622; P=0.022). Conclusion: Macrolide resistance was a significant risk factor in patients with RMP and identification of macrolide resistance might be helpful in predicting RMP and establishing target therapy for RMP.

하계 남해연안에 출현하는 Acartia 속 요각류의 공간 분포

최서열,서민호,신경순,장민철,서호영 한국환경생물학회 2019 환경생물 : 환경생물학회지 Vol.37 No.3

The occurrence patterns of Acartia (Copepoda; Calanoida) species, A. erythraea, A. hongi, A. hudsonica, A. ohtsukai, and A. sinjiensis, were examined in the southern coastal waters of Korea in the summer in August 2012. The Acartia species had different spatial distribution according to environmental factors. A. erythraea showed higher density in a semi-closed bay (Gamak, Masan) where the dissolved oxygen was low (<2 mg L-1). A. sinjiensis showed a high density in a semi-closed bay when the chlorophyll-a concentration was >2 μg L-1. A. ohtsukai showed a high density at water temperatures >26°C and low salinity <30. A. hongi and A. hudsonica showed at water temperatures <27°C and high dissolved oxygen (>5 mg L-1). These results suggest that environmental factors (temperature, salinity, dissolved oxygen, and chlorophyll-a concentration) may affect the spatial distribution of Acartia species dominant in the southern coasts of Korea in summer. 2012년 8월 1일부터 7일까지 한국 남해 연안의 목포에서 부산에 이르는 37개의 정점에서 채집된 Acartia 속 요각류의 공간 분포 양상에 대하여 분석하였다. A. erythraea는 용존산소가 2 mg L-1 이하인 반 폐쇄적인 (가막만, 마산만) 만에서 높은 출현 개체수를 보였다. A. sinjiensis는 엽록소-a 농도가 2 μg L-1 이상인 반 폐쇄적인 만에서 높은 출현 개체수를 보였다. A. ohtsukai는 수온 26°C 이상, 염분 30 이하일때 높은 출현 개체수를 보였다. A. hongi, A. hudsonica는 수온이 27°C 이하, 용존산소 5 mg L-1 이상인 해역에서 출현하였다. 이러한 결과 환경요인이 여름철 남해 연안에 출현하는 Acartia 속 요각류의 공간적 분포에 영향을 미칠 수 있음을 시사하고 있다.

후기 미숙아에서 생후 2개월에 진단된 중증 거대 세포바이러스 감염

최서열 ( Seo Yeol Choi ),이건송 ( Kun Song Lee ) 대한소아감염학회 2016 Pediatric Infection and Vaccine Vol.23 No.2

여러 기관을 침범하는 중증 주산기 거대세포바이러스 감염은 극저출생체중아 또는 면역저하 환자 이외의 경우에는 매우 드물다. 저자들은 재태연령 34주 6일, 2,460 g으로 출생한 후기 미숙아에서 다기관(중추신경계, 간, 폐, 위장관)을 침범한 거대세포바이러스에 의한 주산기 감염을 의심하고 ganciclovir투약 후 회복된 증례를 경험하여 문헌 보고하는 바이다. Severe cytomegalovirus (CMV) infection involving multiorgan is very rare except in very low-birth weight infants, or in immunocompromised pediatric patients. We report an unusual case of severe CMV infection involving multiple organs including the central nervous system, liver, lung, and gastrointestinal tract in a late-preterm infant at 2 months of age.

Neurodevelopmental Outcomes According to Brain Injury Patterns in Neonates with Postasphyxial Hypoxic Ischemic Encephalopathy

정승연,최서열,장영표,이영석 대한신생아학회 2017 Neonatal medicine Vol.24 No.1

Purpose: To investigate the relationship between brain injury patterns on magnetic resonance imaging (MRI) and neurodevelopmental outcomes in neonates with postasphyxial hypoxic ischemic encephalopathy (HIE). Methods: Clinical characteristics and brain MRI findings of 49 term neonates with postasphyxial HIE were retrospectively reviewed. Brain injury patterns in MRI were classified into five categories, along with evaluation of the posterior limb of internal capsule (PLIC). Neurodevelopmental outcomes were assessed by neurological examination combined with the Bayley Scales of Infant Development II between 1 and 2 years of age. Results: Twenty-three neonates (46.9%) showed abnormal brain MRI finding associated with poor neurodevelopmental outcomes (odds ratio 9.7, 95% confidence interval 1.4, 67.4, P=0.022). The following injury patterns were seen in MRI: abnormality in the basal ganglia-thalamus (BGT) in 4 neonates (17.4%), watershed predominant (WP) pattern in 5 (21.7%), extensive global injury (EGI) in 3 (13.0%), lesions restricted to periventricular white matter (LPWM) in 4 (17.4%), and perinatal arterial ischemic stroke (PAIS) in 2 (8.7%). Additionally, 6 neonate (26.1%) showed lesion in the PLIC. Neonate with BGT and EGI injury patterns showed worse neurodevelopmental outcomes than those with WP and LPWM patterns (P<0.05). Neonate with PLIC lesion also showed poor outcomes (100%). Conclusion: Abnormal brain MRI findings in neonates with postasphyxial HIE were associated with the poor neurodevelopmental outcomes. BGT, EGI and PLIC patterns of injury are expected to have worse outcomes than white matter predominant injury patterns such as those in the WP and LPWM.

한국 연안에 출현하는 부유성 요각류의 종다양성과 주요 종의 분포특성

서민호,최서열,박은옥,정달상,서호영 한국환경생물학회 2018 환경생물 : 환경생물학회지 Vol.36 No.4

The Korean coast is divided into the West Korea Coastal zone (WKC), the South Coastal zone of Korea (SCK), the East Korea Coastal zone (EKC), and Jeju Coastal zone of Korea (JCK). Each coastal zone has different marine environment characteristics. This study analyzed zooplankton data of KOEM (Korea Environment Management Corporation) collected in the Korean coastal waters the spring and summer of 2015 and 2016. In spring, water temperature was lowest in the JCK, and gradually increased in the order of EKC, SCK, and WKC, while in summer lowest in WKC and increased in the order of EKC, SCK, and JCK. Salinity was lowest in WKC which had many rivers flowing inland, and increased in the order of SCK, EKC and JCK in spring. In summer it was lowest in JCK and increased toward WKC, SCK, and EKC. In summer, Chlorophyll-a concentrations were generally low, but was lowest in JCK in spring. In the study area, a total of 77 species occurred, of which 50 species did in spring and 65 species in summer. The number of species was lowest in JCK and highest in SCK in spring and summer, respectively. Paracalanus parvus s. l. was the most dominant species or the second dominant species in Korean coastal areas in spring, but it was predominant in summer. In addition, in spring Acartia hongi, Calanus sinicus, Oithona similis were predominant in WKC, Oithona similis and Corycaeus affinis in SCK, O. similis and Corycaeus sp. in EKC, C. affinis and O. setigera in JCK. In summer Corycaeus spp., O. similis, A. hongi, Tortanus forcipatus were predominant in WKC, C. affinis, Pseudodiaptomus marinus in SCK, O. similis, A. omorii, Corycaeus sp. in EKC, and A. steueri, A. pacifica, Oithona sp., C. sinicus in JCK. The copepod community in the Korean coastal areas were classified into four areas, WKC-western SCK, eastern SCK, EKC and JCK according to differences in environmental factors such as water temperature, salinity, Chl-a concentration, and suspended matter concentration of each coastal area. 각기 다른 해양 환경 특성을 보이는 서해, 남해, 동해, 제주 연안역을 대상으로 춘계 (5월)와 하계 (8월)에 출현한 부유성 요각류의 군집구조에 대하여 분석하였다. 봄과 여름에 출현한 부유성 요각류는 총 73종이었으며, 이 중 연안종이 28종이었다. 봄 (49종)에 비해 여름 (58종)에 출현 종이 다양하였다. 요각류 출현 개체수는 봄과 여름 Chl-a 농도가 낮게 나타난 동해연안해역에서 가장 낮았으며, 봄에 Chl-a 농도가 높게 나타난 서해연안해역에서 출현 개체수가 높게 나타났다. 그러나 여름에 제주연안해역에서 Chl-a 농도가 0.6 μg L-1으로 낮게 나타났으나, 높은 출현 개체수를 보였다. 봄에 한국 연안에서 우점적으로 출현하는 요각류는 Acartia hongi, A. ohtsukai, Paracalanus parvus s. l., Oithona similis이었다. 여름에는 이들 종 이외에 A. omorii, A. pacifica, A. steueri, Calanus sinicus, Corycaeus affinis, Corycaeus sp., Pseudodaiptomus marinus, Tortanus forcipatus이었다. Paracalanus parvus s. l.은 봄에 조사 해역에서 최우점종 또는 차우점종으로 생태적 지위를 달리하였으나, 여름에는 전 조사해역에서 최우점종으로 출현하였다. 요각류 군집특성은 수온, 염분, Chl-a 농도 등의 환경 요인에 따라 서해, 남해, 동해, 제주 4구역으로 명확하게 구분되었다.

수정토에 의한 장폐쇄 진단 시 초음파검사의 유용성

김윤수,정현준,최서열,홍경식,서주희,김정례,박윤준,이건송 대한소아응급의학회 2023 대한소아응급의학회지 Vol.10 No.1

Water beads are dangerous foreign bodies causing intestinal obstruction in young children because the beads absorb water and are radiolucent. Although the features lead to progressive intestinal obstruction, it is difficult to diagnose ingestion of the beads by imaging studies. For the diagnosis, ultrasonography is safe, fast, and accurate. The imaging modality can show intestinal water beads as spherical, anechoic, smoothly demarcated cysts. This characteristic finding may be more useful in rapid and accurate diagnosis than computed tomography scan. We report a case of an 8-month-old boy who obtained a timely sonographic diagnosis of water bead-induced small bowel obstruction in the emergency department.

서해 곰소만에 출현하는 동물플랑크톤 군집의 시 · 공간적 변동 특성

정영석,서민호,최서열,추서휘,김동영,이성훈,한경호,서호영 한국환경생물학회 2023 환경생물 : 환경생물학회지 Vol.41 No.4

국내 바지락 주요 산지인 곰소만에서 동물플랑크톤의 시간적 변동과 동물플랑크톤 개체수에 미치는 환경요인을 파악하기 위하여, 2022년 10월, 2023년 1월, 3월, 5월, 총 4번에 걸쳐 10개의 정점에서 동물플랑크톤 채집을 수행하였다. 곰소만의 환경요인들 중 수온, Chl-a, DO, pH는 조사 시기 간에 다른 양상을 보였으며, 염분과 SPM은 조사 시기 간의 통계적인 차이를 보이지 않았다. 곰소만의 동물플랑크톤은 각 조사 시기별로 33개, 29개, 27개, 29개의 분류군이 출현하였으며, 2022년 10월과 2023년 5월에는 절지동물이, 2023년 1월과 3월에는 원생동물이 주로 우점하였다. 절지 동물 중 가장 많은 비율을 차지하는 요각류 (Copepods) 중 우점종은 Acartia hongi, Paracalanus parvus s. l., Corycaeus spp., Oithona spp.로, 국내 전 연안과 황해 연안에 주로 분포하는 종들이었다. 동물플랑크톤 개체수를 기반으로 수행한 집괴 분석 결과는 계절 내에서 정점 간 유사도가 낮아 군집이 구분되지 않는 안정된 상태(stable condition)였으며, 계절 간에서는 3개의 군집 (가을, 겨울~초봄, 봄)으로 뚜렷하게 구분되어 이 해역은 계절성이 매우 강한 환경을 시사하고 있다. To understand the spatiotemporal distribution pattern of zooplankton and the environmental factors influencing zooplankton abundance in Gomso Bay, major harvesting area of Manila clam (Venerupis philippinarum) in South Korea, zooplankton sampling was conducted four times in autumn (October 2022), winter (January 2023), early spring (March 2023), and spring (May 2023). Among the environmental factors of Gomso Bay, water temperature, chlorophyll a concentration (Chl-a), dissolved oxygen (DO), and pH observed different patterns, while salinity and suspended particulate matter (SPM) showed no significant statistical differences between the survey periods. The zooplankton in Gomso Bay occurred 33, 29, 27, and 29 taxonomic groups during each respective survey period. In October 2022 and May 2023, arthropod plankton were dominated, while in January and March 2023, protozoa were primarily dominant. Among the Arthropods, copepods including Acartia hongi, Paracalanus parvus s. l., Corycaeus spp., and Oithona spp. commonly found along Korean coastal areas of the Yellow Sea, were dominated. Cluster analysis based on zooplankton abundance indicated a single community (stable condition) in each season, attributed to low dissimilarity distances, while three distinct clusters (autumn, winter-early spring, spring) between seasons indicated a highly seasonal environment in Gomso Bay.