소아의 흉수 치료에 있어서 유로키나제 효과

남가연,박희주 대한소아청소년과학회 2007 Clinical and Experimental Pediatrics (CEP) Vol.50 No.7

폐격리증의 임상양상

남가연,박희주 대한 소아알레르기 호흡기학회 2008 Allergy Asthma & Respiratory Disease Vol.18 No.1

Purpose:Pulmonary sequestration is characterized by a mass of non-functioning pulmonary tissue lacking normal communication with the tracheobronchial tree and receiving an aberrant systemic arterial blood supply. Two types have been described:intralobar and extralobar. Symptoms vary from the incidental finding of a mass to recurrent bronchitis or pneumonia, chest pain and hemoptysis. In this study, we evaluated clinical features and outcomes of pulmonary sequestration. Methods:The records of the patients diagnosed with pulmonary sequestration by thoracic computerized tomography and aortography between January 1997 and July 2007 were retrospectively reviewed. Results:Fourteen patients (6 males and 8 females) with an median age of 5.5 years in children, 35 years in adults were diagnosed with pulmonary sequestration. Nine patients had clinical symptoms including recurrent respiratory infections, chest pain and hemoptysis. Six patients were symptom free. The aberrant arteries originated from descending thoracic aorta in 12 cases, abdominal aorta in 2 cases, inferior phrenic artery in 1 case. Thirteen patients received surgical operations with open thorax in 11 patients and with video-assisted thoracotomy surgery (VATs) in 2 cases recently diagnosed. Eleven cases (84.6%) were found to be of intralobar type and 2 cases (15.4%) were of extralobar type. One patient had bilateral pulmonary sequestration. All patients with preoperative symptoms improved after surgical treatment. Conclusion:The patients who presented with recurrent pneumonia in the same site, hemoptysis and chest pain should be studied to rule out pulmonary sequestration. Purpose:Pulmonary sequestration is characterized by a mass of non-functioning pulmonary tissue lacking normal communication with the tracheobronchial tree and receiving an aberrant systemic arterial blood supply. Two types have been described:intralobar and extralobar. Symptoms vary from the incidental finding of a mass to recurrent bronchitis or pneumonia, chest pain and hemoptysis. In this study, we evaluated clinical features and outcomes of pulmonary sequestration. Methods:The records of the patients diagnosed with pulmonary sequestration by thoracic computerized tomography and aortography between January 1997 and July 2007 were retrospectively reviewed. Results:Fourteen patients (6 males and 8 females) with an median age of 5.5 years in children, 35 years in adults were diagnosed with pulmonary sequestration. Nine patients had clinical symptoms including recurrent respiratory infections, chest pain and hemoptysis. Six patients were symptom free. The aberrant arteries originated from descending thoracic aorta in 12 cases, abdominal aorta in 2 cases, inferior phrenic artery in 1 case. Thirteen patients received surgical operations with open thorax in 11 patients and with video-assisted thoracotomy surgery (VATs) in 2 cases recently diagnosed. Eleven cases (84.6%) were found to be of intralobar type and 2 cases (15.4%) were of extralobar type. One patient had bilateral pulmonary sequestration. All patients with preoperative symptoms improved after surgical treatment. Conclusion:The patients who presented with recurrent pneumonia in the same site, hemoptysis and chest pain should be studied to rule out pulmonary sequestration.

폐격리증의 임상양상

남가연 ( Ga Yeon Nam ),박희주 ( Hee Ju Park ) 대한소아알레르기 및 호흡기학회 2008 소아알레르기 및 호흡기학회지 Vol.18 No.1

일개 신생아중환자실 반코마이신 저항 장구균(VRE)의 유행 양상과 조절

서정호,남가연,박경희,변신연,박수은 대한소아감염학회 2010 Pediatric Infection and Vaccine Vol.17 No.1

Purpose:Recently, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in Korea. However, there have been few studies on the epidemiology of VRE colonization among neonates. In this study, we investigated the prevalence of VRE colonization, risk factors for VRE, and how to control the spread of VRE infection in the Neonatal Intensive Care Unit (NICU) of Pusan National University Hospital (PNUH). Methods:We retrospectively reviewed medical records of 192 neonates who were admitted to the NICU of PNUH from March 2006 to March 2007. Surveillance cultures from rectal swabs for detecting VRE were obtained weekly during the study period. We analyzed the prevalence of VRE and various risk factors. Results:The rate of VRE colonization among NICU patients was 25% (48/192). Thirty five of these VRE colonized patients were transferred to the NICU from other local hospitals. Compared with the non-VRE group, the risk factors associated with VRE colonization were lower birth weight, congenital heart disease, applied mechanical ventilation, use of a central venous catheter, chest tubing, a history of surgery, and use of antibiotics. Conclusion:VRE colonization among patients admitted to the NICU is rapidly increasing. Monitoring and managing premature neonates from the beginning of the birth process, avoiding many invasive procedures, avoiding antibiotics such as vancomycin and third generation cephalosporin are important for preventing the emergence and spread of VRE colonization in the NICU. 목 적:부산대학교병원 신생아 중환자실에서 2006년3월 VRE 유행이 나타나 입원 환아를 대상으로 대변VRE 감시 배양을 시행하였다. 본 연구는 VRE 감염의정착정도를 파악하고, 위험인자를 분석하여 향후 VRE의출현을 예방하고자 본 연구를 시행하였다. 방 법: 2006년 3월부터 2007년 3월까지 본원 신생아 중환자실 환아 192명을 대상으로 주 1회 대변 감시배양 검사를 시행하였다. VRE가 분리된 환아의 위험인자를 규명하고자 성별, 재태 기간, 기저 질환, 이전 치료에 사용된 항생제의 종류, 침습적 처치의 유무 등을 의무기록을 바탕으로 후향적으로 조사하였다. 결 과:총 192명의 환아 중 VRE 양성군은 48명(25%), VRE 음성군은 189명(75%)이었다. VRE 양성 환아 중 본원 출생아는 12명(25.0%), 타병원 출생아는 36명(75.0%)이었다. VRE 양성 환아의 기저 질환으로는선천성 심질환이 25명(52.1%)으로 VRE 양성 빈도가유의하게 높았다(P =0.005). 항생제 중 VRE 양성군에서 3세대 cephalosporin 사용(45.8% vs. 15.3%, P <0.001)과 vancomycin 사용(95.8% vs. 40.9%, P <0.05)의 기왕력이 통계적으로 유의하게 높음을 알 수 있었다. 또한 VRE 양성군에서 중심 정맥 도관(41.7% vs. 15.3%, P <0.001)이나 인공 호흡기(41.7% vs 25.0%,P =0.017)를 사용한 예가 많았고, 수술 여부(41.7% vs 16.7%, P =0.001)나 흉관 삽입의 기왕력(10.4% vs 2.7%, P =0.021)이 통계적으로 유의하게 높았다. VRE 양성군 48명 중 11명(22.9%)에서 VRE 음전을 확인 하였고 VRE의 음전기간의 중앙값은 101일 이었다. 결 론: VRE 감염은 신생아 중환자실에서 중요한 원내 감염으로 부각되고 있다. 이러한 VRE 집락을 차단하기 위해서는 철저한 감염 관리와 격리를 해야 하며 침습적인 기구의 사용 및 불필요한 항생제의 사용을 줄이려는 노력이 필요하다.

후두 침범의 단일 증상으로 발현한 전신홍반루푸스 1예

이영아,정상건,김성헌,남가연,박재홍 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.4

Laryngeal involvement is a rare complication of systemic lupus erythematosus (SLE) and can range from mild mucosal inflammation, vocal cord paralysis, and edema to necrotizing vasculitis with airway obstruction. Cricoarytenoid arthropathy is rare cause of severe airway obstruction in laryngeal involvement of SLE. In contrast to patients with rheumatoid arthritis, patients with SLE typically present with acute arthritis of cricoarytenoid joints and respond to corticosteroid therapy alone. We describe here a 13-year-old girl with SLE who presented with intermittent fever, swallowing difficulty, vocal cord paralysis and acute dyspnea required emergent tracheostomy as the sole manifestation of active SLE. She was diagnosed as having SLE based on the findings of positive anti-nuclear antibody and anti-ds DNA antibody with high titers, hypocomplementemia, leukocytopenia, and transient polyarthritis and proteinuria. No other clinical symptoms were found. Endoscopic findings showed edema of aryepiglottic fold, bilateral fixation of the vocal cords and edematous supraglottic structure with engorged vessels. Computered tomography scan of the neck showed diffuse soft tissue edema around the arytenoid and cricoid cartilages and enhancement of the aryepiglottic fold.

후두 침범의 단일 증상으로 발현한 전신홍반루푸스

이영아 ( Young Ah Lee ),정상건 ( Sang Geon Jeong ),김성헌 ( Seong Heon Kim ),남가연 ( Ga Yeon Nam ),박재홍 ( Jae Hong Park ) 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.3

Laryngeal involvement is a rare complication of systemic lupus erythematosus (SLE) and can range from mild mucosal inflammation, vocal cord paralysis, and edema to necrotizing vasculitis with airway obstruction. Cricoarytenoid arthropathy is rare cause of severe airway obstruction in laryngeal involvement of SLE. In contrast to patients with rheumatoid arthritis, patients with SLE typically present with acute arthritis of cricoarytenoid joints and respond to corticosteroid therapy alone. We describe here a 13-year-old girl with SLE who presented with intermittent fever, swallowing difficulty, vocal cord paralysis and acute dyspnea required emergent tracheostomy as the sole manifestation of active SLE. She was diagnosed as having SLE based on the findings of positive anti-nuclear antibody and anti-ds DNA antibody with high titers, hypocomplementemia, leukocytopenia, and transient polyarthritis and proteinuria. No other clinical symptoms were found. Endoscopic findings showed edema of aryepiglottic fold, bilateral fixation of the vocal cords and edematous supraglottic structure with engorged vessels. Computered tomography scan of the neck showed diffuse soft tissue edema around the arytenoid and cricoid cartilages and enhancement of the aryepiglottic fold.