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장유진,최일락,신원섭,이장훈,김윤경,박문성 대한소아청소년과학회 2013 Clinical and Experimental Pediatrics (CEP) Vol.56 No.2
Purpose: To evaluate the effectiveness of new management policies on the incidence of invasive Candida infections Methods: This observational study involved a retrospective analysis of the patients’ medical records. In total, 99 very low birth weight infants, who were admitted to the neonatal intensive care unit at Ajou University Hospital from January 2010 to December 2011, were enrolled for the study. Period I, defined as the period before the revision of management policies, comprised 57 infants; whereas, period II,defined as the period after the implementation of new management policies, comprised 42 infants. The new management policies entailed a reduction in antibiotic and histamine type 2 receptor blocker (H2blocker) use, duration of central venous catheterization, and duration of endotracheal intubation. Results: There was a significant overall decrease in the use of antibiotics including 3rd generation cephalosporin and H2 blockers (P<0.05), and a significantly lower incidence of invasive Candida infections in period II as compared to period I (0/42 vs. 6/57, respectively; P =0.037). Comparison between infants with invasive Candida infections (n=6) and those without (n=93) showed that gestational age (odds ratio [OR], 0.909; 95% confidence interval [CI], 0.829 to 0.996; P =0.042) and the duration of 3rd generation cephalosporin use (OR, 1.093; 95% CI, 1.009 to 1.183; P =0.029) were statistically significant risk factors. Conclusion: The new management policies effectively decreased overall use of antibiotics, especially 3rd generation cephalosporin, and H2 blockers, which led to a significantly lower incidence of invasive Candida infections.
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신생아에서 발생한 위중한 상부위장관 출혈: 증례 보고 2예
장유진,최일락,이정주,신원섭,장주영,이장훈,박문성 대한신생아학회 2012 Neonatal medicine Vol.19 No.2
Neonatal upper gastrointestinal bleeding is rare in healthy full term infants and is known to be caused by stress ulcer, intracranial hemorrhage, increased intracranial pressure, congenital heart disease, perinatal asphyxia, respiratory distress, hypoglycemia and use of drugs such as steroids. Mallory-Weiss syndrome and hemorrhagic gastritis can cause life threatening upper gastrointestinal bleeding and are rarely reported in neonates and young infants. The authors experienced a case of Mallory-Weiss syndrome in a full term infant without particular perinatal history and a case of acute hemorrhagic gastritis in a preterm infant born at 33 weeks of gestation and 2,260 g of birth weight, both showed life threatening upper gastrointestinal bleeding. We report these two cases with a review of current literature. 신생아에서 발생하는 상부위장관 출혈은 건강한 만삭아에서 드물게 발생하며 스트레스성 궤양, 두개 내 출혈, 두개강 내압 상승, 선천성 심질환, 가사, 호흡 부전, 저혈당 및 스테로이드 등의 약물 사용등이 위험인자로 알려져 있다. Mallory-Weiss 증후군과 출혈성 위염은 위중한 상부위장관 출혈을 일으키는 질환으로 신생아를 비롯한영유아에서는 그 보고가 매우 드물다. 저자들은 특별한 주산기 병력이 없는 만삭아에서 출생직후 발생한 Mallory-Weiss 증후군 1례와출생 재태 33주 5일, 출생 체중 2,260 g 으로 출생한 미숙아에서 출생 3일 째 발생한 급성 출혈성 위염 1례 등 위중한 상부위장관 출혈증세를 보였던 증례 2례를 경험하였기에 문헌 고찰과 함께 이를 보고하는 바이다.
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신원섭 ( Won Sub Shin ),최일락 ( Ii Rak Choi ),김성환 ( Sung Hwan Kim ),이장훈 ( Jang Hoon Lee ),박문성 ( Moon Sung Park ) 대한주산의학회 2012 Perinatology Vol.23 No.3
Beals syndrome, also known as Beals-Hecht syndrome or congenital contractural arachnodactyly, is arare, autosomal dominant connective tissue disorder. It is characterized by crumpled ears, arachnodactyly, congenital contractures and scoliosis. A male infant of 37+5 weeks of gestation, and with birth weight of 3170 grams, had features of a long and narrow face, bilateral crumpled inferior helix, prominent antihelix of the ears, bilateral arachnodactyly, clenched position of the hands and flexion contractures of the elbows and knees. The infant had tachypnea and chest retractions shortly after birth, and was diagnosed with transient tachypnea of newborn with pneumothorax. He was subsequently treated with positive pressure ventilation and chest tube insertion. Chromosomal karyotype analysis was normal and screening for Marfan syndrome was negative. Echocardiographic findings were unremarkable. Cranial ultrasonography showed a left lateral ventricle dilatation of 0.5 cm and increase up to 1.2 cm on follow up. Brain MRI showed a progression of dilatation of the left ventricle, and a ventriculo-peritoneal shunt was done at 3 months of age. We present a case of a newborn male with Beals syndrome, accompanied with ventricular dilatation and progression to hydrocephalus that has not been previously reported.
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