재발성 호흡기 증상을 동반한 병적 위식도 역류 질환에서 이중 채널 식도내 pH 검사의 의의

최윤창,문경래,Choi, Yun-Chang,Moon, Kyung-Rye 대한소아소화기영양학회 2003 Pediatric gastroenterology, hepatology & nutrition Vol.6 No.1

목 적: 24시간 이 중 채널 식도 pH 검사를 하여 위식도 역류와 호흡기 증상과의 상호 관계를 알아보고 호흡기 증상이 있는 역류 환자에서 원위부와 근위부 식도 pH 측정치를 비교하고자 연구하였다. 방 법: 1998년 8월부터 2002년 8월까지 조선대학교병원 소아과에 위식도 역류의 증상이 있거나 3주일 이상의 만성 기침 등 잦은 호흡기 증상이 있어 식도 pH 검사를 실시한 34명 중 원위부 식도에서 병적인 역류를 보인 17명을 대상으로 하였다. 병적 역류의 기준은 95백분위수 이상의 역류지표 (reflux index)를 병적 역류로 정의하였다. 결 과: 1) 대상 34명에서 호흡기 증상이 있는 16명 중 12명(75%), 호흡기 증상이 없는 18명 중 5명(28%)에서 원위부 식도에서 병적 역류를 보였다. 2) I군에서 근위부와 원위부의 역류 지수, 총 역류횟수, 5분 이상 지속된 역류의 횟수, 최장 역류 시간 등 모든 항목들이 유의한 차이를 보였다(P<0.05). 3) II군에서 근위부와 원위부의 최장 역류 시간을 제외한 모든 항목들이 유의한 차이가 없었다(P>0.1). 4) 근위부 식도에서 I군과 II군의 모든 항목들이 유의한 차이가 없었다(P>0.5). 결 론: 원위부 위식도 역류를 보이는 환자에서 호흡기 증상의 유무에 따라 근위부 식도 pH 검사 결과의 모든 항목에서 차이를 보이지 않아 재발성 호흡기 증상을 보이는 환자에서 이중채널 식도 pH검사의 유용성에 대해 재고가 필요할 것으로 판단된다. Purpose: The aim of this study was to determine clinical significance of dual-probe esophageal pH monitoring and to compare four pH monitoring parameters between proximal and distal esophagus in pathological gastroesophageal reflux disease with recurrent respiratory symptoms. Methods: Among the thirty-four patients who were performed 24 hr pH monitoring, seventeen patients with pathological distal reflux were classified into two groups: Group I (n:12) had recurrent respiratory symptoms and Group II (n:5) hadn't recurrent respiratory symptoms. The ambulatory dual-probe esophageal pH monitoring was performed for 18~24 hr. A pathologic GER was defined when reflux index (percent of the investigation time a pH<4) exceeded the 95th percentile of normal value. Results: Among the sixteen patients with recurrent respiratory symptoms, twelve patients (75%) have pathological distal reflux. Whereas among the eighteen patients without recurrent respiratory symptom, five patients (28%) have pathological distal reflux. In the Group I, the significant differences between proximal and distal esophageal pH recordings persisted for all parameters, but didn't persist in group II except for longest episode. Comparing esophageal pH four parameters between group I and group II at the proximal esophageal site, all parameters didn't show statistically significant differences. Conclusion: Regardless of respiratory symptoms, patients with pathological distal reflux didn't show statistically significant differences in the all parameters at the proximal esophageal site. Therefore we may reconsider usefulness of dual probe pH meter in patients with recurrent respiratory symptoms.

팔꿈치관절의 구축을 동반한 Fetal Valproate 증후군 1례

최윤창,김은영,문경래,노영일,Choi, Yun Chang,Kim, Eun Young,Moon, Kynug Rye,Rho, Young Il 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.10

Fetal valproate syndrome has been described as a distinctive pattern of minor anomalies of the face and digits. This pattern has not been delineated completely but appears to involve brachycephaly with a high forehead, shallow orbit, ocular hypertelorism, small nose, small mouth, low set posteriorly rotated ears, long overlapping fingers and toes, and hyperconvex fingernail. Cleft palate and congenital heart disease have occasionally been described in babies exposed to valproate during embryogenesis. We report a neonate born from an epileptic mother receiving sodium valproate during pregnancy. This neonate presented with characteristic facial abnormalities, both elbow contractures, and overlapping of right first and second toe, forth and fifth toe, and left first and second toe. This case raises the possibility that these abnormal appearances might be caused by intrauterine valproate exposure. 저자들은 임신 1개월 전 전신강직간대성 발작이 있어 임신 중에 발작 조절을 위해 valproate를 복용한 산모의 아이에게서 양 팔꿈치의 구축을 동반한 fetal valproate syndrome의 특징을 지닌 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

IIIa 회장 폐쇄증 환자에서 원위부 회장루를 통한 근위부 공장루 분비물의 지속적 점적 영양 관리 1례

양은석,최윤창,김은영,문경래,장정환,Yang, Eun Seok,Choi, Yun Chang,Kim, Eun Young,Moon, Kyung Rye,Chang, Jeong Hwan 대한소아소화기영양학회 2004 Pediatric gastroenterology, hepatology & nutrition Vol.7 No.2

IIIa형 회장 폐쇄증 환자에서 수술 후 경구 수유와 원위부 회장루를 통한 지속적인 위장관 영양의 병행으로, 하부 위장관 성장을 도모하고 총 정맥 영양의 합병증 등을 감소하였으며 정상적으로 체중이 증가한 1례를 경험하여 보고하는 바이다. Short-bowel syndrome is functionally defined as a state of malabsorption following loss of small bowel, which comprises the sequelae of nutrient, fluid, and weight loss. The proximal segment of the bowel of a patient with intestinal atresia is usually grossly distended and atonic. In contrast, distal segment is smaller. For this reason, anastomosis of the proximal and the distal segment is technically difficult and may cause no propulsion even when they are anastomosed. We experienced that continuous drip ileostomy feeding with the secretions from the proximal stoma stimulated the distal bowel to accommodate and resolved many sequelae following loss of small bowel in a patient with short-bowel syndrome due to IIIa ileal atresia.

단일 대학병원의 지역의약품안전센터에 보고된 소아청소년의 약물유해반응 분석

김도우 ( Do-woo Kim ),최윤창 ( Yun-chang Choi ),이영석 ( Young-seok Lee ),남영희 ( Young-hee Nam ),정진아 ( Jin-a Jung ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.5

Purpose: Adverse drug reactions (ADRs) are a recurring problem among pediatric patients, and the incidence is increasing. However, there have been only a few studies on the clinical presentation of pediatric ADRs in Korea. This study investigated the clinical presentation of ADRs and the causative drugs in pediatric patients from a single university hospital. Methods: We retrospectively collected the data on pediatric ADRs as reported to the Regional Pharmacovigilance Center in Dong-A University Hospital between March 2013 and July 2016. We analyzed clinical presentations associated with the events. To determinate causality, we evaluated each ADR according to the Naranjo probability scale, the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) criteria and the Korean ADR algorithm. Results: A total of 365 ADR cases were reported. Sixty-eight patients (26.5%) responded to 2 or more drugs. Antibiotics (43.3%) were the most common causative drugs, of whom the third generation cephalosphorins caused most ADRs. The most common clinical presentations were gastrointestinal manifestations (36.6%). A total of 312 ADRs were reported in 257 patients based on both the Naranjo probability scale and the Korean ADR algorithm. In addition, 323 ADRs were reported in 257 patients based on the WHO-UMC criteria. Conclusion: Various drugs are related to ADRs in pediatric patients. Further efforts to improve ADR-reporting systems and to increase awareness of ADRs in pediatric patients are needed. (Allergy Asthma Respir Dis 2018;6:263-269)

소아 만성 자발성 두드러기 치료와 관련된 인자

조선영 ( Sun-young Cho ),최윤창 ( Yun-chang Choi ),김병권 ( Byoung-gwon Kim ),정진아 ( Jin-a Jung ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.4

Purpose: Chronic spontaneous urticaria (CSU) in children is a common skin disorder, but its clinical course varies. We investigated the clinical course and associated factors for CSU treatment in children. Methods: A total of 107 children, diagnosed with CSU from 2001 to 2016 in Dong-A University Hospital, who had been followed up for more than 6 months after treatment, were enrolled. The laboratory findings, and clinical aspects and courses were retrospectively investigated by a medical record review. We divided the 152 patients into 3 groups according to the treatment modalities: group 1, 1 antihistamine; group 2, more than 2 kinds of antihistamines; and group 3, antihistamines plus leukotriene receptor antagonist. Results: The mean age of patients in group 3 was 3.4 years (range, 2.6-4.2 years), which was significantly lower than those at the other 2 group patients (P=0.01). The urticaria activity score (UAS) of group 3 (6.1 [5.7-6.6]) was significantly higher compared to those of the other 2 groups (P=0.01). The improvement rate of the condition in children with positive specific immunoglobulin E (sIgE) reactivity to food or inhalant allergens was significantly lower than that of children with negative sIgE reactivity (P=0.01). Sex, age, history of allergic diseases, disease duration, UAS, previous treatment, and treatment modality were not correlated with the symptom improvement rate. Conclusion: Younger children and those with higher UAS needed more medication to ensure the improvement in symptoms. Moreover, it took more time for the improvement in symptoms in children who were sensitized to food or inhalant allergens. (Allergy Asthma Respir Dis 2017;5:211-216)

팔꿈치관절의 구축을 동반한 Fetal Valproate 증후군 1례

최윤창,김은영,문경래,노영일 대한소아과학회 2002 小兒科 Vol.45 No.10