최근 총폐정맥 환류이상의 임상 경과 및 수술 결과 : 단일 대학병원에서의 경험(총폐정맥 환류이상의 최근 결과)

추미애,최병호,최희정,김여향,김근직,조준용,이상범,현명철 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.2

목 적 : 총폐정맥 환류이상은 드문 선천성 심장질환이나, 진단 즉시 완전 교정 수술이 필요한 질환이며 폐정맥 협착 동반 유무에 따라 수술 사망률과 예후가 다르게 보고되고 있다. 이번 연구는 총폐정맥 환류이상 환아를 조사하여 이들의 임상적 특성과 수술 후 경과를 살펴보고자 시행하였다. 방 법 : 1994년 1월부터 2008년 2월까지 14년간 경북대학교병원에서 총폐정맥 환류이상으로 진단된 환아 27명의 의무 기록 정보를 후향적으로 분석 하였다. 결 과 : 총폐정맥 환류이상 환아 27명은 남아 17명, 여아 10명이었고, 진단 시 나이는 평균 28.1±33.4일(1-126일), 평균 체중은 3.6±0.9 kg (1.9-6.3 kg)였다. 병원을 방문한 주 증상으로 빈호흡, 저산소증 등의 호흡기 증상이 7명, 수유 시 청색증이나 전신 청색증이 13명, 심잡음이 7명이었다. 13명(48.1%)에서 심부전 소견을 보였다. 심초음파 검사로 진단된 해부학적 형태로 심상부형이 15명(55.6%), 심형이 6명(22.2%), 심하부형이 5명(18.5%)이고 혼합형은 1명(3.7%)있었다. 수술 전 폐정맥 협착이 동반된 경우는 7명으로 심상부형에서 5명, 심형과 심하부형에서 각각 1명이었다. 본원에서 수술 받은 환아는 총 24명으로 수술 중 경식도 초음파 검사는 14명(58.3%)에서 시행 하였다. 수술 중 경식도 초음파 검사를 사용한 경우의 사망률은 0%이고 사용하지 않은 경우의 사망률 40%로 유의한 차이(P<0.05)를 보였다. 수술 사망은 4명(16.7%)으로, 수술하지 않고 사망한 환아 2명을 포함하여 전체 사망률은 22.2%였다. 그러나 수술 시기를 2000년을 기준으로 구분하여 살펴보면, 사망한 4명 모두 2000년 이전 이었으며(사망률 50%, 4/8명), 2000년 이후에는 수술 후 사망이 한 명도 없었다(사망률 0%, 0/18명). 수술 후 폐정맥의 협착은 심초음파 검사로 진단하여 5명에서 발생 하였다. 5명중 3명은 수술 부위의 협착이고 나머지 2명은 폐정맥 자체의 협착이었다. 수술 부위의 협착을 보인 3명은 재수술을 시행 하였고(평균 기간 : 24일) 재수술 후 사망률은 0%이며, 현재 모두 약물치료는 시행하지 않으며 특별한 증상도 보이지 않으나 3명 모두 정기적으로 시행한 심초음파에서 후기 재 협착 소견을 보였다. 이들이 수술 부위의 후기 재 협착이 진단되기까지의 평균 기간은 31.3개월(17-54개월)이었다. 폐정맥 자체의 협착을 보인 환아는 2명으로, 교정 수술 후 심초음파 검사로 진단되기까지의 기간은 각각 3개월과 84개월이었다. 추적 관찰되었던 환아 20명에서 평균 관찰 기간은 24.2±24.9개월(2-80개월)이었다. 결 론 : 수술 후 폐정맥 협착 및 수술 부위의 재 협착이 발생할 수 있으므로 수술 중 경식도 초음파 검사의 적극적 이용과 수술 후 정기적이고 지속적인 관리가 필요할 것으로 생각된다. Purpose : Active perioperative intervention and improvement on surgical technique has decreased the mortality rate of total anomalous pulmonary venous connection (TAPVC); however, when complicated with pulmonary venous obstruction, operative mortality is still high. The purpose of this study was to investigate the clinical course of TAPVC. Methods : Twenty-seven patients who were diagnosed with TAPVC (without other complex heart anomalies) by echocardiogram at Kyungpook National University Hospital from January 1994 to February 2008 were included. Results : Mean age at diagnosis was 28.1±33.4 days (1-126 days). Sites of drainage were supracardiac type (15), cardiac (6), infracardiac (5), and mixed (1). Seven patients had pulmonary venous obstruction: 5 with supracardiac type, 1 with cardiac, and 1 with infracardiac. Intraoperative trans-esophageal echocardiograms were performed in 14 patients (58.3%). The operative mortality was 16.7% (4 of 24) and overall hospital mortality (including deaths without operation) was 22.2% (6 of 27). There were 5 postoperative pulmonary venous obstructions. The sites of obstruction were anastomotic in 3 of 5 (60%) patients, and ostial pulmonary vein in the other 2 (40%) patients. Three patients who presented with anastomotic pulmonary venous obstruction underwent reoperation, but all the patients were found to have pulmonary venous anastomotic obstruction. The other 2 patients with ostial pulmonary vein obstruction who had no significant symptoms were diagnosed by routine echocardiographic examination during follow-up. Conclusion : In TAPVC patients, early diagnosis and aggressive surgical management will improve prognosis, and we must pay attention to early and late pulmonary vein restenosis through intraoperative trans-esophageal echocardiogram and peri- and post-operative echocardiographic follow-up examinations.

초등학생의 자기효능감과 학습동기 및 학교적응간의 관계

추미애,박아청 한국아동교육학회 2006 아동교육 Vol.15 No.2

제1차 「 지방포럼 」 개최 - 한국의 21세기 지방에 달렸다 - / 제2주제 : 지방정치의 현실과 새로운 패러다임 모색 [ 토론 ] : 주민참여 위한 지방정치의 과제

추미애 한국지방행정연구원 1999 지방포럼 Vol.1 No.-

의학강좌/한국 소아청소년 비만과 대사 증후군

추미애,최병호 대한의사협회 2010 대한의사협회지 Vol.53 No.2

Obesity is a disease that decreases life span. Childhood obesity leads to the higher prevalence of obesity in adulthood, which increases the risk of metabolic syndrome. Recently, the prevalence of obesity and metabolic syndrome is rapidly increasing among children and adolescents in Korea. The percentage of affected individuals was 17.9% among 10 to 14year-old boys at its highest or 9.7% (boys 11.3%, girls 8.0%) on average, according to KNHANES III (The Third Korea National Health and Nutrition Examination Survey, 2005) and 2005 Korean children and adolescents' growth standard program, respectively. The incidence of metabolic syndrome was 30 to 40% in obese children and adolescents in Korea. Intervention program to prevent and reduce childhood obesity on a national scale is required.

영유아 급성 설사의 영양 공급: 탈수 치료 후 연령별 식이요법을 중심으로

추미애,최병호,Chu, Mi Ae,Choe, Byung-Ho 대한소아소화기영양학회 2009 Pediatric gastroenterology, hepatology & nutrition Vol.12 No.suppl1

The mainstay in the management of mild to moderately dehydrated children is fast rehydration by using hypotonic ORS (oral rehydration solution) and complete resumption of normal diet, including lactose-containing formula after 4 hours rehydration. Since the majority of young children with uncomplicated acute diarrhea will tolerate large amounts of undiluted non-human milk, withholding food and milk from children during diarrhea is not recommended anymore, regarding time to resolution and diarrhea control. In addition, routine dilution of milk and routine use of lactose-free formula are not necessary after fast ORS therapy. Breastfed infants and children fed with solid foods may safely continue receiving their usual diets during diarrhea instead of gradual reintroduction of feeding. However, young infants or children with severe diarrhea or malnutrition should be carefully treated under supervision if fed with lactose containing, non-human milk exclusively.

점포 혼잡성이 점포태도와 행동의도에 미치는 영향 - 소비자 동조성의 조절효과를 중심으로

추미애,Choo, Mi-Ae 한국정보통신학회 2014 한국정보통신학회논문지 Vol.18 No.4

점포 내 혼잡성이 점포태도와 행동의도에 어떠한 영향을 미치는지 조사하고 점포태도 형성 과정에서 나타나는 소비자동조성의 조절적 영향력을 분석하는데 그 목적이 있다. 점포혼잡도 요인으로 사회적 혼잡성과 공간적 혼잡성으로, 행동요인은 구전의도와 재방문의도를, 소비자동조성은 높은집단과 낮은집단으로 제시하였다. 사회적 혼잡성은 점포태도에 유의한 정(+)의 영향을 미치는 것으로 나타났으나, 공간적 혼잡성은 유의하지 못하였다. 행동의도 중 재방문의도는 통계적으로 유의한 관계가 있는 것으로 나타났으나, 구전의도는 유의한 영향관계가 없는 것으로 나타났다. 소비자동조성의 조절효과를 살펴 본 결과 소비자동조성이 높은 집단은 사회적 혼잡성에 큰 영향을 미치는 것으로 나타났으며, 공간적 혼잡성에서 낮은 영향을 미치는 것으로 나타났다. Attitudes and behavior within the store congestion of the store is a store in any manner affect the formation process of investigating synchronism in the control of the consumer appears to analyze the influence of enemy has its purpose. Store and spatial congestion factor of social behavioral factors also revisit the help of word-of-mouth is. Consumer groups with high and low groups of synchronism suggested. Social attitudes towards the store congestion significantly positive effect that I've shown, it was not significant spatial congestion. During a revisit of action is a statistically significant relationship that I've shown, is a significant effect of word-of-mouth relationship was not significant. Investigating the moderating effects of consumer synchronism result of high consumer groups a significant impact on the social congestion showed, at low spatial influence congestion.

디지털환경에서 매체몰입이 브랜드 애착과 브랜드충성도에 미치는 영향: 브랜드 관계감정의 계층적 매개효과 분석

추미애,Choo, Mi-ae 한국정보통신학회 2015 한국정보통신학회논문지 Vol.19 No.12

In this study, consumer to use digital media is investigated on media engagement, Brand Attachment, Brand Relations Affect and Brand Loyalty of relation. also analyzing the mediating effect of brand relations affect and brand influence in the relationship between media engagement and brand attachment step has its purpose. Data analysis result showed that media engagement is significant effect on Brand Relations Affect and Brand Attachment, Brand relations Affect and Brand Attachment is significantly effected on the brand loyalty. And mediating Effect of brand Relation Affect was investigated by adjusting role between media engagement and brand attachment. Media engagement and brand relations, the influence of the brand attachment, brand relations affect has a greater effect. 본 연구에서는 디지털 매체를 사용하는 소비자들의 매체몰입과 브랜드 애착, 브랜드 관계감정, 브랜드 충성도의 관계를 알아보고자 하였다. 또한, 매체몰입과 브랜드 애착 단계의 관계에서 브랜드 관계감정의 매개 효과 관계와 영향력을 분석하는 데 그 목적이 있다. 자료 분석 결과, 매체몰입은 브랜드 관계감정과 브랜드 애착에 유의한 영향을 미치고 있는 것으로 나타났으며, 브랜드 관계감정과 브랜드 애착은 브랜드 충성도에 긍정적 영향을 미치는 것으로 나타났다. 그리고 브랜드 감정의 매개 효과를 살펴본 결과 매체몰입과 브랜드 애착 사이에 조절적 역할을 하는 것으로 조사되었다. 매체몰입과 관계감정이 브랜드 애착에 미치는 영향력은 관계감정이 더 큰 영향을 미치고 있음을 확인할 수 있었다.

Respiratory syncytial virus에 의한 급성 세기관지염에서 혈청 내 surfactant protein-D 상승의 의의

추미애 ( Mi Ae Chu ),이은주 ( Eun Joo Lee ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),김우택 ( Woo Taek Kim ),정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회 1991 소아알레르기 및 호흡기학회지 Vol.1 No.3

Purpose: Collectin family is an important component of innate immunity, of which surfactant protein (SP)-D and mannose-binding lectin (MBL) are the most characterized. We examined SP-D and MBL in young children with acute respiratory syncytial virus (RSV) bronchiolitis. Methods: Sixty-three children (≤24 months of age) admitted with the first RSV bronchiolitis during 2 epidemics and followed for 1 year after discharge were enrolled. The patients were defined as severe group when they had 2 of followings during admission: hypoxemia (<92% oxygen saturation), rapid breathing (and/or lower chest wall indrawing), and >7 days of hospital stay. All children were evaluated if they had recurrent wheezing during follow-up. SP-D and MBL were measured using enzyme-linked immunosorbent assay in serum collected on admission and compared with controls. Their levels were evaluated in relation to the symptom severity during admission and recurrence of wheezing after discharge. Results: Serum SP-D increased significantly in the patients (P<0.01), but MBL showed no difference compared to the controls. SP-D levels were significantly higher in severe group compared with nonsevere group (P<0.05). SP-D levels in the patients with recurrent wheezing after discharge were significantly higher than in those without (P<0.05). MBL showed no difference in relation to the symptom severity or recurrence of wheezing. Conclusion: Our study showed that serum SP-D was associated with the severity of RSV bronchiolitis and suggests that it might be a biomarker of lung injury and recurrence of wheezing illnesses in the young children admitted with their first RSV bronchiolitis. (Allergy Asthma Respir Dis 2013;1:235-240)

소아 천식군과 영유아 천명군에서 혈청 내 가용성 ST2 상승의 의의

추미애 ( Mi Ae Chu ),이형직 ( Hyung Jik Lee ),이은주 ( Eun Joo Lee ),홍석진 ( Suk Jin Hong ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회 1991 소아알레르기 및 호흡기학회지 Vol.1 No.4

Purpose: Soluble ST2 (sST2) has been reported to regulate Th2 response. In this study, serum levels of sST2 and other cytokines were measured in recurrent early wheezers and asthmatic children. We aimed to investigate if there are any differences or similarities in Th1 or Th2 response between those two patient groups. Methods: Fifty-nine patients admitted with exacerbation of wheezing or asthma were enrolled. Two patient groups were defined: children with atopic asthma (≥6 years, n=21) and recurrent early wheezers (≤2 years, n=38). Recurrent early wheezers were divided based on their atopic status: 19 were atopic and 19 were nonatopic. sST2, interleukin (IL) 33, IL-5, and interferon (IFN)-γ were measured in serum samples collected on admission. Cytokine levels in both patient groups were compared with their age-matched controls and evaluated the relationship with blood eosinophils, serum IgE levels, and also with the severity of symptom. Results: sST2 and IL-5 were significantly increased both in asthmatic children (P=0.02, P=0.004) and recurrent early wheezers (P=0.01, P=0.001) compared to their age-matched controls. IL-5 was significantly higher in atopic wheezers compared with nonatopic wheezers (P=0.04). Severity score showed a positive correlation with sST2 and IFN-γ in asthmatic children, but only with IFN-γ in early wheezers. There was an inverse correlation between sST2 and blood eosinophil counts both in asthmatic children and atopic recurrent wheezers. Conclusion: Our study suggests that sST2 might regulate allergic inflammation by suppressing eosinophilia and play an important role in pathophysiology of acute exacerbation of wheezing or asthma both in asthmatic children and early wheezers. (Allergy Asthma Respir Dis 2013;1:314-320)

Respiratory syncytial virus에 의한 급성 세기관지염에서 혈청 내 surfactant protein-D 상승의 의의

추미애 ( Mi Ae Chu ),이은주 ( Eun Joo Lee ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),김우택 ( Woo Taek Kim ),정혜리 ( Hai Lee Chung ) 대한소아알레르기호흡기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.3

Purpose: Collectin family is an important component of innate immunity, of which surfactant protein (SP)-D and mannose-binding lectin (MBL) are the most characterized. We examined SP-D and MBL in young children with acute respiratory syncytial virus (RSV) bronchiolitis. Methods: Sixty-three children (≤24 months of age) admitted with the first RSV bronchiolitis during 2 epidemics and followed for 1 year after discharge were enrolled. The patients were defined as severe group when they had 2 of followings during admission: hypoxemia (<92% oxygen saturation), rapid breathing (and/or lower chest wall indrawing), and >7 days of hospital stay. All children were evaluated if they had recurrent wheezing during follow-up. SP-D and MBL were measured using enzyme-linked immunosorbent assay in serum collected on admission and compared with controls. Their levels were evaluated in relation to the symptom severity during admission and recurrence of wheezing after discharge. Results: Serum SP-D increased significantly in the patients (P<0.01), but MBL showed no difference compared to the controls. SP-D levels were significantly higher in severe group compared with nonsevere group (P<0.05). SP-D levels in the patients with recurrent wheezing after discharge were significantly higher than in those without (P<0.05). MBL showed no difference in relation to the symptom severity or recurrence of wheezing. Conclusion: Our study showed that serum SP-D was associated with the severity of RSV bronchiolitis and suggests that it might be a biomarker of lung injury and recurrence of wheezing illnesses in the young children admitted with their first RSV bronchiolitis. (Allergy Asthma Respir Dis 2013;1:235-240)