국내 병원 형태 어디로 가야하나 : ㆍ영리법인으로 할 것인가? ㆍ비영리법인으로 할 것인가?

윤종서 약업신문사 2000 의약정보 Vol.2000 No.1

Current Status of Pediatric Critical Care in Korea: Results of 2015 National Survey

윤종서,장원경,최유현,이봉진,김윤희,조화진,은병욱,김진태,김경원,조중범,신홍주,류정민,정재희,유영,허준,박성종,박준동 대한의학회 2018 Journal of Korean medical science Vol.33 No.49

Background: The aim of this study was to describe the structure, organization, management, and staffing of pediatric critical care (PCC) in Korea. Methods: We directed a questionnaire survey for all Upper Grade General Hospitals (n = 43) in Korea in 2015. The first questionnaire was mainly about structure, organization, and staffing and responses were obtained from 32 hospitals. The second questionnaire was mainly about patients and management. Responses to second questionnaire were obtained from 18 hospitals. Results: Twelve from 32 Upper Grade General Hospitals had pediatric intensive care units (PICUs) and 11 of them had the PICU which was exclusive for children. Total number of PICU beds in Korea was 113. The ratio of the number of PICU beds to the number of children was 1:77,460 in Korea and this ratio is lower than that of other developed countries. The mean number of beds in the PICUs was 9.4 ± 9.3 (range, 2–30). There were 16 medical doctors who were assigned for PCC and only 5 of them were full time pediatric intensivists. In the 18 Upper Grade General Hospitals that responded to the second questionnaire survey, there were 97 patients in the PICUs with an average number of 5.7 ± 7.2 (range, 0–22) on the survey day. The mean age of the patients was 3.4 ± 5.6 years. The mean length of hospital stay was 82 ± 271 days. The mean Pediatric Risk of Mortality score III was 9.4 ± 7.8 at the time of admission to the PICUs. Conclusion: There is a considerable shortage of PICU beds compared to those in developed countries. In addition, the proportion of PICUs with PCC specialists is much lower than those in the US and European countries.

세기관지염 환아의 혈청에서 ECP, RANTES, Eotaxin 치의 비교

윤종서,이미희,이준성 대한소아과학회 2004 小兒科 Vol.47 No.2

F-143 : Free Paper Presentation ; Late-Onset Non-Infectious Pulmonary Complications after Pediatric Allogeneic Hematopoietic Stem Cell Transplantation

윤종서,전윤홍,이재욱,장필상,정낙균,조빈,김학기,이준성 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

Purpose: The incidence, characteristics, and outcomes of late-onset non-infectious pulmonary complications (LONIPCs) in children have not been well studied. Methods: We retrospectively reviewed the medical records of patients aged between 6 and 17 years who underwent allogeneic HSCT. Bronchiolitis obliterans (BO) was diagnosed based on persistent radiographic changes consistent with BO. Bronchiolitis obliterans with organizing pneumonia (BOOP) was diagnosed when there were appropriate HRCT findings without clinical evidence of infection by bronchoalveolar lavage. Results: Of the 103 patients who were included in the study, 17 (16.5%) developed LONIPCs, and 10 and 7 were further diagnosed with BO and BOOP, respectively. Multivariate analysis revealed that the only predictive factor for the development of LONIPCs was chronic GVHD in sites besides the lungs. When these patients were analyzed separately, early development of chronic GVHD in sites besides the lungs was a risk factor of the development of LONIPCs. Conclusions: The present study verifies the increasing incidence and prevalence of LONIPCs after allogeneic HSCT in children. Chronic GVHD in sites besides the lungs was confirmed as a risk factor associated with LONIPC development. In addition, early development of chronic GVHD in sites besides the lungs was a risk factor of LONIPCs. These findings may be used to establish new approaches for diagnosing, monitoring, treating, and investigating LONIPCs. Purpose: The incidence, characteristics, and outcomes of late-onset non-infectious pulmonary complications (LONIPCs) in children have not been well studied. Methods: We retrospectively reviewed the medical records of patients aged between 6 and 17 years who underwent allogeneic HSCT. Bronchiolitis obliterans (BO) was diagnosed based on persistent radiographic changes consistent with BO. Bronchiolitis obliterans with organizing pneumonia (BOOP) was diagnosed when there were appropriate HRCT findings without clinical evidence of infection by bronchoalveolar lavage. Results: Of the 103 patients who were included in the study, 17 (16.5%) developed LONIPCs, and 10 and 7 were further diagnosed with BO and BOOP, respectively. Multivariate analysis revealed that the only predictive factor for the development of LONIPCs was chronic GVHD in sites besides the lungs. When these patients were analyzed separately, early development of chronic GVHD in sites besides the lungs was a risk factor of the development of LONIPCs. Conclusions: The present study verifies the increasing incidence and prevalence of LONIPCs after allogeneic HSCT in children. Chronic GVHD in sites besides the lungs was confirmed as a risk factor associated with LONIPC development. In addition, early development of chronic GVHD in sites besides the lungs was a risk factor of LONIPCs. These findings may be used to establish new approaches for diagnosing, monitoring, treating, and investigating LONIPCs.

Prevalence of Pathological Brain Lesions in Girls with Central Precocious Puberty: Possible Overestimation?

윤종서,소철환,이해상,임중섭,황진순 대한의학회 2018 Journal of Korean medical science Vol.33 No.51

Background: Brain magnetic resonance imaging (MRI) is routinely performed to identify brain lesions in girls with central precocious puberty (CPP). We aimed to investigate the prevalence and type of brain lesions among Korean girls with CPP and evaluate the need for routine brain MRI examinations. Methods: This retrospective cross-sectional study evaluated data on 3,528 girls diagnosed with CPP from April 2003 to December 2016, and identified 317 girls who underwent sellar MRI. Exclusion criteria were patients with a known brain tumor or who did not undergo brain MRI due to refusal or the decision of the pediatric endocrinologist. Results: Normal sellar MRI findings were observed in 291 of the 317 girls (91.8%). Incidental findings were observed in 26 girls (8.2%). None of the patients had pathological brain lesions. Conclusion: The prevalence of intracranial lesions among girls who were generally healthy and without neurological symptoms but diagnosed with CPP was lower than that previously reported. Furthermore, none of the identified lesions required treatment. It may be prudent to reconsider the routine use of brain MRI to screen all patients with CPP, especially if they are healthy and neurologically asymptomatic, and are girls aged 6–8 years.

알루미늄 4343/3003/4343 brazing sheet 의 brazing 특성에 미치는 냉간압연조건의 영향

윤종서,김목순 대한금속재료학회(대한금속학회) 1999 대한금속·재료학회지 Vol.37 No.8

Al 4343(filler)/3003(core)/4343(filler) type of brazing sheet(thickness of 100 ㎛ with each side clad ratio of 10%), which is being widely used in clad fin material for parallel flow type condenser of automobile, was fabricated by casting → hot rolling → cold rolling → intermediate annealing(IA) → final cold rolling(FR), and the relationship between IA/FR condition, microstructure and NOCOLOK brazing characteristics was investigated. When specimen was intermediate annealed at temperatures higher than 330℃, followed by cold rolling with the reduction rate lower than 10%, the core was partially recrystallized during brazing process, including unrecrystallized structure such as sub-grain. In this case, the melted filler infiltrated into the core during brazing through the sub-grain boundary which acts as a preferential penetration path, so the eroded area increased and brazeability decreased. When IA/FR was performed in the condition of 330℃/over 37% or 270℃/over 10%, fine recrystallized grains were formed in the core during the brazing process, which promotes filler penetration through the grain boundary. In this case, brazeability was deteriorated with the increment in eroded area. If IA/FR was carried out in the condition of 420℃/20-45% or 330℃/20-30%, the specimen exhibited superior brazeability with suppressed erosion owing to the formation of coarse recrystallized grains during brazing process.

Successful switching from insulin to sulfonylurea in a 3-month-old infant with diabetes due to p.G53D mutation in KCNJ11

윤종서,박규정,손영배,이해상,황진순 대한소아내분비학회 2018 Annals of Pediatirc Endocrinology & Metabolism Vol.23 No.3

Permanent neonatal diabetes mellitus is most commonly caused by mutations in the ATP-sensitive potassium channel (K ATP ) subunits. Prompt initiation of sulfonylurea treatment can improve glycemic control in children with KCNJ11 mutation. In this report, we present a case of permanent neonatal diabetes caused by a mutation in the KCNJ11 gene that was successfully treated via early switching of insulin to sulfonylurea treatment. A 53-day-old female infant presented with diabetic ketoacidosis. Insulin was administered for the ketoacidosis and blood glucose regulation. At 3 months of age, using genomic DNA extracted from peripheral lymphocytes, direct sequencing of KCNJ11 identified a heterozygous mutation of c.158G>A (p.G53D) and confirmed the diagnosis of permanent neonatal diabetes mellitus. Subsequently, treatment with sulfonylurea was initiated, and the insulin dose was gradually tapered. At 4 months of age, insulin therapy was discontinued, and sulfonylurea (glimepiride, 0.75 mg/kg) was administered alone. At 6 months after initiation of administration of sulfonylurea monotherapy, blood glucose control was stable, and no hypoglycemic events or developmental delays were reported. C-peptide levels increased during treatment with sulfonylurea. Early switching to sulfonylurea in infants with permanent diabetes mellitus owing to a KCNJ11 mutation could successfully help regulate glycemic control, which suggests the need for early genetic testing in patients presenting with diabetes before 6 months of age.

세기관지염 환아의 혈청에서 ECP, RANTES, Eotoxin 치의 비교

윤종서,이미희,이준성 대한소아청소년과학회 2004 Clinical and Experimental Pediatrics (CEP) Vol.47 No.2

Purpose:Viral respiratory infection, especially respiratory syncytial(RS) virus, can predispose sufferers to the development of asthma by mechanisms that are presently undetermined. The role of inflammatory mediators in pathogenesis of asthma and RS virus disease is not well-understood. We investigated the performance of serum eosinophil cationic protein(ECP), regulated on activation normal T-cell expressed and secreted(RANTES) and eotaxin levels on the airway inflammation in a population of patients with RS virus and non-RS virus bronchiolitis, compared with control subjects. Methods:Twenty-eight patients with RS virus positive bronchiolits, 11 patients with RS virus negative bronchiolitis and seven control subjects were enrolled in the study. Serum ECP, RANTES and eotaxin levels were measured by enzyme immunoassay. We analyzed the correlation among serum ECP, RANTES, eotaxin, immunoglobulin E and blood eosinophil count in the RS virus positive bronchiolitis group and the RS virus negative bronchiolitis group, respectively. Results:Both serum ECP and RANTES in the brochiolitis group were not higher than in the control. Serum eotaxin concentration in bronchiolitis group was significantly higher than in control(P= 0.030), but there was no significant difference between RS virus positive and negative groups. There were significant correlations between the peripheral blood eosinophil count and serum ECP, and between the levels of serum ECP and RANTES in the RS virus positive bronchiolitis group(P=0.038, 0.012 respectively). Conclusion:Serum eotaxin may have a systemic effect in pathophysiology of bronchiolitis but ECP and RANTES may not. However, they may have some indirect effects inferred from the correlations among them. 목 적 : RS 바이러스에 의한 세기관지염 후에 기관지천식이 유발되는 기전에 관여하는 것으로 생각되는 ECP, RANTES, eotaxin치의 혈청 농도를 세기관지염 환자군과 대조군에서 측정하여, 세기관지염 환아에서 측정값이 증가하는지 알아보고, 측정값의 증가가 RS 바이러스에 의한 세기관지염에서 특이적인 것인지 알아보았다. 또한 상기 측정값과 혈청 IgE, 말초혈액 내 호산구 수간에 상관관계가 있는지 알아보았다. 방 법 : 2001년 1월 1일부터 12월 31일까지 세기관지염으로 가톨릭대학교 강남성모병원에 입원한 환아 중 39명을 대상으로 하였다. 이들 중 비인두 분비물 검사에서 RS 바이러스가 확인된 환아 28명을 RS 바이러스 양성군으로, RS 바이러스가 검출되지 않은 환아 11명을 RS 바이러스 음성군으로 하였다. 혈청 ECP, RANTES, eotaxin 농도를 측정하여 대조군과 비교하였고, 혈청 IgE, 혈액 내 호산구 수와의 상관관계를 비교분석 하였다.

한국 소아 밀 알레르기 환자에서 밀, 글루텐 및 오메가-5 글리아딘 특이 IgE의 유용성

윤종서 ( Jongseo Yoon ),정경욱 ( Kyunguk Jeong ),이수영 ( Sooyoung Lee ) 대한천식알레르기학회 2016 Allergy Asthma & Respiratory Disease Vol.4 No.2

Purpose: The aim of this study was to assess the clinical usefulness and added diagnostic value of specific IgE antibodies to wheat, gluten, and ω-5 gliadin in diagnosing wheat allergy and distinguishing wheat anaphylaxis. Methods: This study included 196 children who visited Ajou University Hospital for suspicious food allergy. The subjects were divided into 2 groups: the wheat allergy (WA) and non-wheat allergy (non-WA) groups. Patients with wheat allergy were further divided into 2 subgroups according to their symptoms: the wheat allergy with anaphylaxis (WAAna) and wheat allergy without anaphylaxis (WANon-Ana) groups. Serum concentrations of total IgE and specific IgE antibodies to wheat, gluten and ω-5 gliadin were measured. Results: The median values of specific IgE antibodies to wheat, gluten and ω-5 gliadin were significantly higher in the WA group than in the non-WA group, and the positive decision points (95% specificity) were at 3.12, 2.61, and 0.21 kUA/L, respectively. The combination of specific IgE antibodies to wheat and ω-5 gliadin resulted in the highest accuracy of 93.9% in diagnosing wheat allergy. In differentiating the WAAna group from the WANon-Ana group, only specific IgE antibody to ω-5 gliadin showed a significant difference at the optimal cutoff point of 1.56 kUA/L. Conclusion: Our results show that the individual levels of specific IgE antibodies to wheat, gluten or ω-5 gliadin may have a considerably high accuracy in diagnosing wheat allergy and that specific IgE antibody to ω-5 gliadin may be particularly useful in predicting wheat anaphylaxis. (Allergy Asthma Respir Dis 2016;4:119-125)

소아의 호흡기질환에서 수면다원검사의 적용

윤종서 ( Jong Seo Yoon ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.2

In recent years, the field of sleep medicine for children has been significantly developing. Research has shown that polysomnography plays an important role in the diagnosis and management of children with sleep-related breathing disorders. However, evidence-based parameters have not yet been set. This article presents the current indications of polysomnography in children. Accurate diagnosis and management of children with sleep-related breathing disorders are only possible when their polysomnographic parameters and clinical findings such as medical history and physical examination are combined. (Allergy Asthma Respir Dis 2013;1:111-115)