소아 급성 충수돌기염 진단에 지연을 일으키는 요인에 관한 연구

한명기,김경수,박유인,김정호,이정주,김봉성,강혜영,Han, Myung-Ki,Kim, Kyoung-Soo,Park, Yu-In,Kim, Jeong-Ho,Lee, Jung-Joo,Kim, Bong-Seong,Kang, Hye-Young 대한소아소화기영양학회 2002 Pediatric gastroenterology, hepatology & nutrition Vol.5 No.2

목 적: 급성 충수돌기염은 소아 환자에게 가장 흔한 외과적인 응급질환이며 최근의 그 발생 빈도가 감소된다는 보고에도 붙구하고 급성 충수돌기염의 천공으로 인한 합병증의 발생은 호전되고 있지 않고 있다. 소아 환아에서는 과거력과 진찰 소견이 매우 다양하고 비전형적인 경우가 흔해 급성 충수돌기염의 진단은 자주 지연될 수 있고 천공과 복막염, 복강 내 농양 등의 합병증이 발생하여 임상 경과를 어렵게 만들 수 있다. 저자들은 후향적으로 급성 충수돌기염으로 진단 받은 환아를 대상으로 진단 지연의 발생과 진단 지연을 초래한 요인, 진단 지연이 임상 경과에 미치는 영향을 알아보기 위하여 본 연구를 시행하였다. 방 법: 1996년 8월부터 2001년 12월까지 강릉 아산병원에서 급성 충수돌기염으로 진단되어 급성 충수돌기 제거술을 시행 받은 76명을 대상으로 하여 후향적으로 의무 기록을 조사하였으며, 통상 증상을 호소한지 48시간 이상 경과되어 진단이 이루어진 경우를 진단 지연이라고 하고, 48시간 이내 진단이 이루어진 군, 두 군으로 나누어 비교 조사를 하였다. 대상 환아에 대해서 나이, 성별, 진단까지의 시간, 초기 증상, 최초 환자를 검진한 의사의 진료분야, 입원경로, 최초 진단명, 방사선 검사의 효용성, 합병증 유무, 입원 기간 등을 조사하였다. 결 과: 본 연구에서는 설사 증상과 복부 X선 검사 상 분변 박힘 (fecalith impaction) 의 존재 여부가 진단 지연과 관련이 있었다. 또한 처음 접한 의료진에 의해 집에 귀가하여 관찰한 소아에게서 진단 지연이 많았다. 진단 지연군의 절반이상에서, 초기 진단은 급성 충수돌기염이 아닌 위장관염이었다. 진단 지연군에서의 천공률은 87%로 그렇지 않은 군의 22%보다 높았다. 또한 진단지연군에서 더 많은 수술 합병증 발생과 입원 기간을 보였다. 결 론: 비특이적인 증상을 동반하며 복통을 호소하는 소아과 환자를 위장관염, 감기 등 흔한 질환으로 간단히 진단해선 안되며, 급성 충수돌기염의 가능성을 염두에 두고 자세한 병력 청취와 철저한 진찰을 시행하여 급성 충수돌기염의 조기 진단에 노력을 해야 하며, 진단이 부정확한 경우 입원을 권고하고, 조기에 외과적인 의뢰를 시행함과 더불어 복부 초음파 검사, 귀가 후 추적 진찰을 조기에 함으로써 진단의 지연을 줄일 수 있다고 하겠다. Purpose: We designed this retrospective study to establish the incidence of diagnosic delay in children diagnosed with acute appendicitis and to identify associated factors with delayed diagnosis and its impact on the clinical course. Methods: All cases of children under 15 years of age who underwent appendectomy from 1996 to 2001 at Gangneung Asan Hospital were reviewed. We reviewed signs and symptoms, type of health professional first contacted, the advice given by the health professional and a history of appendicitis in first degree relatives. Diagnostic period is the time elapsed between first complaints and definitive diagnosis. Delay was defined as diagnostic period exceeded the 48 hours. Postoperative course and complications were also reviewed. Results: Incidence of diagnostic delay differed by whether diarrhea and fecalith on X-ray were present. Also children whose parents were advised to observe them at home were more likely to have a diagnostic delay. In almost half of the cases in delayed group, initial diagnosis was not acute appendicitis but gastroenteritis. The perforation rate in non-delayed group was 22%, whereas 87% in delayed group. The delayed group showed a higher number of postoperative complication and a longer hospitalization period. Conclusions: Diarrhea with abdominal pain and fever in children should not be dismissed as gastroenteritis, respiratory infections or other common disorders. Our study suggests that physicians have a responsibility to prevent diagnostic delay and resultant perforation of acute appendicitis in children by having a high index of suspicion about acute appendicitis.

Papanicolaou 염색에 대한 염색성 및 선호도에 관한 연구

한명기 ( Myung Ki Han ),김주성 ( Joo Sung Kim ) 대한임상검사과학회 2000 대한임상검사과학회지(KJCLS) Vol.32 No.3

The result of the survey, answered by 76 people in 28 organization, about property by Papanicolaou stain and the preference of specific stain properties is written below. ’The frrst is about preference of specific stain properties. The stain properties much affect eyestrain. πle must popular stain properties are bright and clear colors of nuclei and cytoplasm without stimulus. However the result of the survey shows that a considerable the stain property is chosen by a subjective judgment. The second is about the stability of stain. According to the result, the most satisfying stain property is obtained through the reagent made in own their hands. And the degree of satisfaction at domestic reagents is similar to foreign ones. It seems that the high satisfaction degree in the case of homemade product not because stain property is controlled in reagent production but because it is arranged properIy being considered the surrotmdings of each hospitals. Thirdly, according to the result of comparing stain properties of each reagent, it is analyzed that the preference degree is highest when nuclei and cytoplasm is stained in harmony by each reagent. also it is proved that preference of foreign reagent to domestic reagent is just a prejudice by this research. Judging from the previous researches, there is no unavailable stain reagent for common stain and there are differences about time and method of stain among hospitals one another. Therefore, there isn``t any trouble if we chα)Se the well qualified and controlled reagent companies while we arrange reagents properly by surroundings of each hospital. Furthermore, as a result of this study we can make a conclusion like this: It is just a prejudice to consider that the foreign made reagents are superior to domestic ones.

광해군대의 (光海君代) 대중국 (對中國) 관계 - 후금문제를 (後金) 둘러싼 대명관계를 (對明關係) 중심으로 -

한명기 ( Myung Ki Han ) 진단학회 1995 진단학보 Vol.- No.79

Celloidin에 의한 표본제작

한명기 ( Myung Ki Han ),김성인 ( Seung In Kim ),오근영 ( Keun Young Oh ) 대한임상검사과학회 1986 대한임상검사과학회지(KJCLS) Vol.18 No.1

임상 ; 남북한 신생아학 용어 비교

한명기 ( Myung Ki Han ),김태연 ( Tae Yeon Kim ),박기영 ( Kie Young Park ),김봉성 ( Bong Seong Kim ),이정주 ( Jung Ju Lee ) 대한주산의학회 2007 大韓周産醫學會雜誌 Vol.18 No.2

교환수혈로 치료한 태아로부터 모체로의 대량출혈 2예

이창현 ( Chang Hyun Lee ),김재광 ( Jae Kwang Kim ),한명기 ( Myung Ki Han ),김정욱 ( Jeung Wook Kim ),이정주 ( Jung Ju Lee ) 대한주산의학회 2008 Perinatology Vol.19 No.2

Massive fetomaternal hemorrhage is major cause of neonatal anemia. And neonatal anemia is fatal disease of high mortality rate. Massive fetomaternal hemorrhage is defined as hemorrhage of fetal blood above 150 mL in the maternal circulation. Massive fetomaternal hemorrhage is infrequent but represents a fatal cause of perinatal death. To identify fetal blood in the maternal circulation, Kleihauer-Betke test or flow cytometry has been usually used. But recently HPLC (high performance liquid chromatography) is used in the detection and quantification of fetomaternal transfusion. In fetomaternal transfusion, anemic newborn must be treated when circulatory failure is present. Circulatory failure often necessitates blood transfusion. We report two cases of severe anemia due to massive fetomaternal hemorrhage in full term baby. Each case was diagnosed by high performance liquid chromatography and treated with exchange transfusion in order to avoid fluid overload and subsequent heart failure.

익수 환아의 임상양상과 예후를 예측할 수 있는 인자

김경수(Kyoung Soo Kim),정재일(Jae Il Joung),한명기(Myung Ki Han),김봉성(Bong Seung Kim),박기영(Kie Young Park),이정주(Jung Joo Lee),김정호 (Jeong Ho Kim) 대한소아신경학회 2003 대한소아신경학회지 Vol.11 No.2

목 적 : 익수 환아의 임상경과와 예후에 영향을 미치는 인자들을 알아보고자 본 연구를 시행하였다. 방 법 : 1996년 3월부터 2002년 3월까지 강릉아산병원에 익수되어 내원한 환아 28례를 대상으로 병록지 고찰을 통해 익수 환아의 임사양상을 후향적으로 조사하였다. 또한, 신경학적 후유증 없이 완전히 회복된 좋은 예후군과 사망하거나 심한 신경학적 후유증이 남은 나쁜 예후군으로 구분하여 두 군 사이의 차이를 조사하였다. 결 과 : 28례 중 남아가 18례(64.3%), 여아가 10례(35.7%)로 남아가 많았다. 연령별로는 4세 이하가 10례(35.7%), 5-8세가 7례(25.0%, 9-12세가 8례(33.3%), 13-16세가 3례(10.7%)였다. 계절별로는 여름이 18례(64.3%), 봄이 6례(21.4%), 가을이 3례(10.7%), 겨울이 1례(4.2%)였다. 침수시간에 따란 5분 미만이 15례(53.6%), 5분 이상 10분 미만이 6례(21.4%)였다. 신경학적 후유증 없이 완전히 회복된 좋은 예후군은 28례 중 23례(82.1%), 신경학적 후유증이 있거나 사망한 나쁜 예후군은 식물인간상태 1례, 사망례 4례를 포함하여 5례(17.9%)였다. 좋은 예후군과 나쁜 예후군 사이에 성별, 나이, 계절, 침수장소, 이송시간, 응급심폐소생술 시행 여부에 따른 분류에서 두 군간 통계학적으로 유의한 차이가 없었으나, 침수시간, 기계환기요법의 적용 여부, 초기 혈당치, 초기 동맥혈 pH가 좋은 예후군과 나쁜 예후군 사이에 차이를 나타냈다. 결 론 : 익수 환아에서 침수시간이 10분 이상인 경우, 기계환기요법을 받은 경우, 초기 혈당치가 높은 경우, 초기 동맥혈 pH가 낮은 경우 신경학적 예후가 나쁠 것으로 예상된다. Purpose : We intended to find out clinical aspects and prognostic factors of near drowning children in this study. Methods : We conducted a retrospective study on twenty eight near-drowning children, who were admitted to Gangneung Asan Hospital from March, 1996 to March, 2002. We investigated their clinical aspects and the differences between two groups, namely a good prognosis group and a poor prognosis group. Those in the good prognosis group had no neurologic impairments and were fully recovered while those in the poor prognosis group died or fell into vegetative states. Results : Out of 28 patients, there were 18 males(64.3%) and 10 females(35.7%). Age distribution was ≤4 years in 10 cases, 5 to 8 years in 7 cases, 9 to 12 years in 8 cases, and 13 to 16 years in 3 cases. Seasonal distribution was summer in 18 cases, spring in 6 cases, autumn in 3 cases, and winter in 1 case. Submersion time was ≤5 minutes in 15 cases, 5 to 10 minutes in 7 cases, and unknown in 7 cases. Initial blood glucose level was 175.2±88.0 mg/dL and initial arterial blood pH was 7.24±0.21. Good prognosis group had 23 out of 28 cases(82.1%) while poor prognosis group had 5 out of 28 cases(17.9%) which included 4 deaths and 1 vegetative case. Between the two groups there were no significant differences in the distributions of sex, age, season, submersion place, transfer time to hospital and resuscitation time. However, submersion time, mechanical ventilation need, initial blood glucose level and initial arterial pH were significantly different between the two groups. Conclusion : We found out that poor prognosis is expected for near-drowning children of submersion time over 10 minutes, applied mechanical ventilation, high initial blood glucose level, and low initial arterial blood pH.

소아 아토피피부염에서 중증도 및 흡입 항원 감작과 요중 leukotriene E4농도의 연관성

신순정 ( Soon Jung Shin ),김민지 ( Min Jee Kim ),정민희 ( Min Hee Jung ),진현승 ( Hyun Seong Jin ),한명기 ( Myung Ki Han ),박기영 ( Kie Young Park ),오미영 ( Mi Young Oh ),김봉성 ( Bong Seong Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.3

Purpose: Atopic dermatitis (AD) is a genetically determined, chronic relapsing skin disease. The pathogenesis of AD is complex and the course is unpredictable. Atopy is an important risk factor for the development of AD. Cysteinyl leukotrienes (Cys-LTs) were implicated in the pathophysiology of allergic diseases, and are being targeted for their diagnosis and treatments. Early detection of tissue inflammation of target organ is important to enable early prevention and management of allergic diseases. The aim of our study is to evaluate the differences in urinary leukotrienes E4 (LTE4) levels, according to AD symptom score and aeroallergen sensitization in children with AD by using noninvasive techniques. Methods: We recruited 46 children with AD, using predetermined criteria. Clinical features of AD were evaluated by a physician, using scoring atopic dermatitis (SCORAD) index. Aeroallergen sensitization was measured by using a skin prick test and UniCap. Urine samples were also collected on day of the 1st and 2nd visits, and were analyzed for LTE4 with an enzyme-linked immunoassay kit. Results: SCORAD indeces of children with AD were correlated with urinary LTE4 levels. Total immunoglobulin E (IgE) and eosinophil counts also had significant correlation with urinary LTE4 levels. Especially, aeroallergen sensitization of atopic AD significantly correlated with urinary LTE4 of these patients. Conclusion: Urinary LTE4 levels significantly correlated with serum total IgE and number of sensitized aeroallergen in children with AD. Clinical features of AD evaluated with SCORAD index related with urinary LTE4 level. Urinary LTE4 might be a valuable, noninvasive marker for different pathogenesis of AD.

Papanicolaou stain의 시간단축 및 시약절약을 위한 세포질염색시약의 연구

김순재 ( Soon Jae Kim ),이문정 ( Moon Jung Lee ),조민호 ( Min Mo Cho ),박노진 ( Noh Jin Park ),마상철 ( Sang Chul Ma ),한명기 ( Myung Ki Han ) 대한임상검사과학회 2000 대한임상검사과학회지(KJCLS) Vol.32 No.3

Currently, Orange-G and EA50 are being used in Papanicolaou stain. The simplification of this two reagents is studied in this research. According to the result, the most favorable arrangement condition is like the following. 1) It is proved that the most satisfactoη stain property is made when Orange-G is 2.5ml, Light green is 4.5ml and Eosin-Y is 7.0ml in the aspect of density. 2) The best qulified stain property is made up when the pH is 5.0-5.5 in the aspect of pH in mixed reagent. Therefore, for the optimum mixture of reagents, you should mix Orange-G 2.5ml, Light geen 4.5ml and Eosin-Y 7.아nl together, and then, add alcohol whose alcoholicity is 95 percent to it whεn it comes to the amount of 1α)()ml. And you shou1d add phosphotungstic acid 2g, saturated solution of lithium carbonate O.5ml and glacial acetic acid to it in a row lUltil it comes to pH5.0-5.5.

명청교체기 동북아 질서와 조선 지배층의 대응

한명기 한국역사연구회 2000 역사와 현실 Vol.- No.37