환자의뢰제도를 통한 일차보건사업의 병원과 연계에 관한 실험적 연구

임경진,염용태,이명숙 고려대학교 의과대학 1992 고려대 의대 잡지 Vol.29 No.1

This study had been carried out in Yeoju Kun, Kyunggi Province as a part of Commumity Health Development Pilot Programme of Korea University. The aim of this study is to confirm the possibility that the private university hospital in a rural community could be participated in primary health care services by way of cooperative management of case referral system between the university hospital and other primary health care (PHC) facilities. The PHC facilities included health subcenters of which directors were public health doctors and primary health units carried by specially trained nurses. As the results of experiment in this study, it was clarified that the private university hospital was potentially able to be participated if mutual benefits be esisted. Furthermore, it would be actively involved in case referral system including follow-up programme of referred cases after discharge. Other products of this approach was great role of the hospital in regular refreshment education for public health doctors and nurses devoting in PHC services during the system development. There were some by-products obtained analysing data from referred patients and hospital records collected from Jan. to Dec. 1989. The data was sorted by a computer system of Database package of which results were summarized as follows : 1. Among referred cases, there were 32.0% of male and 68.0% of female. As the age of cases increased, the proportional frequency increased. Of them, only 25.9% had experience to visit the university hospital before. 2. The most of cases (44.3%) subjected to medicine department and the next (16.4%) to orthopedics. Concerning the category of sickness which caused referring, 21.1% of cases belonged to diseases of digestive system, 17.2% to symptoms and ill-defined conditions, 14.1% to diseases of musculo-skeletal system and connective tissues. Of them, 82.0% took chronic course of illness.

Evaluation of risk for graft-versus-host disease in children who receive less than the full doses of mini-dose methotrexate for graft-versus-host disease prophylaxis in allogeneic hematopoietic stem cell transplantation

Yum, Sook Kyung,Choi, Hye-Yoon,Lee, Jae Wook,Jang, Pil-Sang,Chung, Nack-Gyun,Jeong, Dae-Chul,Cho, Bin,Kim, Hack-Ki The Korean Pediatric Society 2013 Clinical and Experimental Pediatrics (CEP) Vol.56 No.11

Purpose: The use of cyclosporine and mini-dose methotrexate (MTX) is a common strategy for graftversus- host disease (GVHD) prophylaxis in allogeneic transplants. We investigated whether patients who receive fewer than the planned MTX doses are at increased risk for GVHD. Methods: The study cohort included 103 patients who received allogeneic transplants at the Department of Pediatrics of The Catholic University of Korea College of Medicine, from January 2010 to December 2011. MTX was administered on days 1, 3, 6, and 11 after transplant at a dose of 5 $mg/m^2$ each. Within the cohort, 76 patients (74%) received all 4 doses of MTX [MTX(4) group], while 27 patients (26%) received 0-3 doses [MTX(0-3) group]. Results: Although there was no difference in neutrophil engraftment between the 2 groups, platelet engraftment was significantly faster in the MTX(4) group (median, 15 days), compared to the MTX(0- 3) group (median, 25 days; P =0.034). The incidence of grades II-IV acute GVHD was not different between the MTX(4) and MTX(0-3) groups (P =0.417). In the multivariate study, human leukocyte antigen mismatch was the most significant factor causing grades II-IV acute GVHD (P =0.002), followed by female donor to male recipient transplant (P =0.034). No difference was found between the MTX(4) and MTX (0-3) groups regarding grades III-IV acute GVHD, chronic GVHD, and disease-free survival. Conclusion: Our results indicate that deviations from the full dose schedule of MTX for GVHD prophylaxis do not lead to increased incidence of either acute or chronic GVHD.

극소 저체중 출생아에서 뇌실 내 출혈의 중증도 관련 위험 요인과 신경발달학적 예후

천미경 ( Mi Kyung Cheon ),염숙경 ( Sook Kyung Yum ),문청준 ( Cheong Jun Moon ),윤영아 ( Young Ah Youn ),김소영 ( So Young Kim ),성인경 ( In Kyung Sung ) 대한주산의학회 2014 Perinatology Vol.25 No.4

목적 : 극소 저체중 출생아(very low birth weight infant, VLBWI)에서 뇌실 내 출혈(ntraventricular Hemorrhage,IVH)의 중증도 관련 주산기 요인들을 알아보고, 생존한 VLBWI에서 IVH의 중증도에 따른 신경발달 예후도 알아보고자 하였다. 방법 : 2009년 5월부터 2013년 4월까지 가톨릭의대 부속 서울성모병원 신생아 집중치료실에서 치료받았던 재태 연령 37주 미만의 미숙아로서 출생 체중 1.5 kg 미만인 VLBWI 중 IVH이 확인된 145명을 대상으로 후향적으로 분석하였다. IVH 중증도 관련 요인들을 출생 전 요인, 산과적 요인, 출생 후 요인으로 구분하여 1+2단계 IVH군과 3+4단계 IVH군 간에 통계적으로 유의한 차이가 있는지 알아보았다. 신생아기 사망 26명과 퇴원 후 추적 관찰에서 누락된 11명을 제외한108명을 대상으로 IVH 중증도에 따른 신경발달 예후를 조사하였다. 신경발달 예후는 인지 발달 장애, 뇌성마비, 시각및 청각 장애, 뇌전증 등 중증 신경발달 장애가 있는 경우에 대해서 조사하였다. 중증 신경발달 장애는 108명 중 23명(21.3%)에서 조사되었다. 결과 : 재태 연령과 출생 체중이 중증 IVH 발생과 관련된 출생 전 요인이었다. 낮은 1분 및 5분 아프가 점수, 저혈압/쇼크, 동맥혈 최대 이산화탄소 분압, 동맥과 개존증의 존재, 기흉, 혈소판 감소증, 무호흡 발작, NEC, 중등도 이상의 기관지 폐 형성이상 등이 중증 IVH 발생과 관련된 출생 후 요인이었다. 이들 요인들을 대상으로 다중 회귀분석을 한 결과, 낮은 재태연령과 작은 출생 체중, 저혈압/쇼크가 중증 IVH 발생과 관련된 독립적인 인자였다. 중증 신경발달 장애는 중증 IVH에서 생존한 VLBWI에서 유의하게 빈도가 높았다. 결론 : VLBWI에서 조산 예방과 더불어 중증 IVH 위험 요인인 저혈압/쇼크를 최소화하는 것이 중증 신경발달 장애를최소화하는 방침이다. Purpose : The purpose of this study is to investigate the perinatal risk factors for severity of intraventricularhemorrhage (IVH) in very low birth weight infants (VLBWIs) and to study the following neurodevelopmentaloutcomes depending on the degree of IVH severity. Methods : The retrospective study included 145 VLBWIs who were admitted at Seoul St. Mary’s Hospitalbetween May of 2009 and April of 2013. Prenatal, obstetric and postnatal risk factors for IVH were investigated. VLBWIs were divided into the group of IVH grade 1-2 and IVH grade 3-4. During this study period, 26VLBWIs were died and 11 VLBWIs were lost to followed up, thereby 108 infants were included in the finalanalysis. They were regularly followed up and assessed for presence of major neurodevelopmental impairmentsincluding cognitive impairment, cerebral palsy, visual deficit, hearing deficit, and epilepsy. Among 108 infants,23 (21.3%) patients had neurodevelopmental impairments. Results : The lower gestational age and birth weight were significant prenatal risk factors for severe IVH. Lower Apgar score at 1 and 5 min, hypotension/shock, higher levels of partial pressure of carbon dioxide,presence of patent ductus arteriosus, pneumothorax, thrombocytopenia, necrotizing enterocolitis, andbronchopulmonarydysplasia were significant postnatal risk factors for severe IVH. After multiple logisticregression analysis, gestational age, birth weight, and hypotension/shock were independent risk factors forsevere IVH. The incidence of major neurodevelopmental impairments were also significantly higher inVLBWIs who survived after severe IVH. Conclusion : In addition to preterm birth, minimizing hypotension/shock, the risk factor of severe IVH, isimportant to prevent major neurodevelopmental impairments in VLBWIs.

Descending Aorta Blood Flow Characteristics before the Development of Necrotizing Enterocolitis in Preterm Neonates

Kyung Min Kim,Hyo Sup Kim,Ji Hong Yoon,Eun-Jung Lee,Sook Kyung Yum,Cheong Jun Moon,윤영아,Yoo Jin Kwun,이재영,성인경 대한신생아학회 2018 Neonatal medicine Vol.25 No.2

Purpose: To investigate the hemodynamic risk factors for necrotizing enterocolitis (NEC), we analyzed the characteristics of descending aorta (DA) blood flow in preterm neonates, who later developed NEC. Methods: This was an observational case-control study on 53 preterm neonates at a tertiary referral center. Clinical and echocardiographic data were collected from 23 preterm neonates with NEC (NEC group), and compared with those of 30 preterm neonates without NEC (control group). Echocardiography was done at a median (interquartile range) of 5 (3-9) days after birth and 2 (1-2.5) days before the diagnosis of NEC. Results: Basic clinical characteristics including gestational age, birth weight, Apgar score, breast feeding status, use of umbilical catheters, and mode of invasive ventilator care were similar between the groups. Compared with the control group, the lowest diastolic velocity of DA was significantly decreased, whereas the diastolic reverse flow and the ratio of diastolic reverse to systolic forward flows were significantly increased in the NEC group. In addition, the resistive index (RI) of DA was significantly increased in the NEC group and showed a positive association with the development of NEC. Multivariate logistic regression analysis showed that increasing RI of DA was an independent risk factor for the development of NEC (P=0.008). Conclusion: Significant changes in DA flow characteristics including decreased diastolic velocity and increased diastolic reverse flow along with increased peripheral vascular resistance were observed before the development of NEC in preterm neonates. These findings may help clinicians stratify in advance neonates at a risk of developing NEC and may help improve outcomes in these neonates.

Infant Pertussis and Household Transmission in Korea

권효진,Sook Kyung Yum,Ui Yoon Choi,이수영,김종현,강진한 대한의학회 2012 Journal of Korean medical science Vol.27 No.12

A recent resurgence of pertussis has raised public health concerns even in developed countries with high vaccination coverage. The aim of this study was to describe the clinical characteristics of infant pertussis, and to determine the relative importance of household transmission in Korea. The multicenter study was prospectively conducted from January 2009 to September 2011. We identified the demographic and clinical data from these patients and performed the diagnostic tests for pertussis in their household contacts. Twenty-one patients with confirmed pertussis were included in the analysis. All infections occurred in infants younger than 6 months of age (mean age, 2.5 months) who had not completed the primary DTaP vaccination except for one patient. Infants without immunization history had a significant higher lymphocytosis and longer duration of hospital stay compared to those with immunization. All were diagnosed with PCR (100%),however, culture tests showed the lowest sensitivity (42.9%). Presumed source of infection in household contacts was documented in 85.7%, mainly parents (52.6%). Pertussis had a major morbidity in young infants who were not fully immunized. Household members were responsible for pertussis transmission of infants in whom a source could be identified. The control of pertussis through booster vaccination with Tdap in family who is taking care of young infants is necessary in Korea.

Synthesis of crystalline carbon nanotube arrays on AAO templates using catalyst reduction with low pressure TCVD

Yong Sook Shin,Ji Hoon Yang,Min Hyung Yum,Chong-Yun Park,Myeung Hoi Kwon,Ji-Beom Yoo,Chul Woong Yang,Se Jin Kyung,Geun Young Yeom 한국진공학회 2005 한국진공학회 학술발표회초록집 Vol.- No.-

Perinatal prediction model for severe intraventricular hemorrhage and the effect of early postnatal acidosis

Lee, Juyoung,Hong, Mee,Yum, Sook Kyung,Lee, Jung Hyun Springer-Verlag 2018 Child’s nervous system Vol.34 No.11

The Antioxidative Effects of Low Temperature Aged Garlic Extracts

Ga-Ram Kim,Kyung-A Hwang,In-Guk Hwang,Yun Sook Jeong,Eun Ji Yum,Dan-Bi Ryu,Jin Song 한국식품영양과학회 2015 한국식품영양과학회 학술대회발표집 Vol.2015 No.8

Congenital Acute Megakaryoblastic Leukemia in a Neonate with Antenatal Hepatosplenomegaly

( Tao Cheng Lu ),( Jae Wook Lee ),( Sook Kyung Yum ) 대한주산의학회 2021 Perinatology Vol.32 No.1

Various conditions can lead to antenatal hepatosplenomegaly. In addition to commonly known etiologies like hydrops fetalis or viral illnesses, hematologic disorders like congenital leukemia, although rare, should also be ruled out. We present a case of hepatosplenomegaly detected during antenatal screening in a neonate, in whom acute megakaryoblastic leukemia was diagnosed postnatally based on the immunophenotype.

Acute Acalculous Cholecystitis with Bacteremia Caused by Streptococcus anginosus Following Dental Procedure in a Previously Healthy Adolescent

김현오,염숙경,한승범,권효진,강진한,Kim, Hyun O,Yum, Sook Kyung,Han, Seung Beom,Kwon, Hyo Jin,Kang, Jin Han The Korean Society of Pediatric Infectious Disease 2012 Pediatric Infection and Vaccine Vol.19 No.3

Streptococcus anginosus는 Streptococcus milleri group에 속하는 viridians streptococci의 한 종으로, 사람의 구강, 상부 호흡기, 위장관 및 여성 생식기에 정상 세균총으로 존재하며, 숙주의 면역 상태에 따라 질환을 일으킬 수 있다. 저자들은 치과 치료 후 발열, 황달, 우상복부 불편감을 주소로 내원한 건강하였던 15세 남아에서 S. anginosus에 의한 균혈증이 동반된 급성 무결석 쓸개염을 진단하였고, 환아는 항균제 치료 후 호전되었다. 소아 청소년 시기에 흔하지 않은 급성 무결석 쓸개염이 기저 질환 없는 청소년에서 viridians streptococci에 의해 발생한 드문 경우이다. Streptococcus anginosus is a member of Streptococcus milleri group, and is found in the oral mucosa, respiratory tract, and gastrointestinal tract as normal flora. It can develop into a disease in patients with deteriorating clinical condition or with clinical risk factors. A previously healthy 15-year-old boy was admitted due to fever, abdominal discomfort and vomiting which lasted for 7 days. He had a history of dental procedure 1 day before the development of fever. He was diagnosed with acute acalculous cholecystitis based on the clinical, laboratory, and imaging finding, and S. anginosus was isolated from the blood culture. The patient was successfully treated with antibiotic therapy.