소아 선천성 심장병 개심술 후 발생한 조기 부정맥

최희정,김여향,조준용,현명철,이상범,김규태,Choi, Hee-Joung,Kim, Yeo-Hyang,Cho, Joon-Yong,Hyun, Myung-Chul,Lee, Sang-Bum,Kim, Kyu-Tae 대한소아청소년과학회 2010 Clinical and Experimental Pediatrics (CEP) Vol.53 No.4

목 적 : 선천성 심장병의 개심술 직후에 발생하는 부정맥은 술 후 조기 사망의 주된 원인의 하나인데, 이는 심폐 우회술 및 심근보호법의 발달, 술 후 집중치료와 적절한 약물 치료로 감소시킬 수 있다. 이에 이번 연구에서는 선천성 심장병의 개심술 후 조기에 발생한 부정맥의 빈도와 종류, 그 위험 인자들을 조사하여 보았다. 방 법: 2002년 1월부터 2008년 12월까지 선천성 심장병으로 경북대학교병원에서 개심술을 시행받은 561명의 환자를 대상으로 하였다. 이들의 의무기록지를 후향적으로 조사하여 진단명, 수술방법, 수술 후 부정맥이 발생한 시기와 기간, 부정맥의 종류와 치료방법, 부정맥으로 동반된 합병증 및 사망률, 부정맥 발생 당시 혈액 전해질 수치 등을 분석하였다. 결 과 : 소아 개심술 후 조기 부정맥의 빈도는 7.3% (42/578 개심술)로 남아 23명, 여아 18명이었으며, 개심술을 시행 받은 나이는 평균 $8.7{\pm}19.8$개월, 몸무게는 평균 $5.8{\pm}4.0kg$이었다. 발생한 부정맥 종류는 방실 접합부 이소성 빈맥이 17례로 가장 많았고, 다음으로 가속 심실고유 율동이 13례였으며, 또한 대혈관 전위에 대한 동맥 전환술에서 가장 많은 빈도의 부정맥을 보였다(36.4%). 대부분의 부정맥은 치료에 반응이 좋았다. 개심술 후 조기 부정맥의 위험 인자로는 수술 당시 작은 몸무게, 어린 나이, 긴 인공 심폐기 시간과 긴 대동맥 차단 시간이었다($P$<0.05). 부정맥이 발생한 환자에서 그렇지 않은 환자에 비해 인공호흡기 사용시간과 집중치료실 입원기간이 의미있게 길었으나($P$<0.05), 사망률에서는 의미있는 차이가 없었다. 결 론 : 선천성 심장병의 개심술 후 발생하는 조기 부정맥은 주의깊은 감시와 적극적인 치료로 치명적인 결과를 줄일 수 있다. 최근 개심술의 나이가 낮아짐에 따라 술 후 조기 부정맥에 대한 더욱 세심한 관리가 필요할 것으로 생각된다. Purpose : Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. Methods : From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. Results : Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times ($P$<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer ($P$<0.05), the mortality rate was not significantly different among the 2 groups. Conclusion : Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.

용혈위기를 동반한 윌슨병에서 교환 수혈로 회복된 소아 1예

최희정,임해리,최병호,Choi, Hee-Joung,Lim, Hae-Ri,Choe, Byung-Ho 대한소아소화기영양학회 2006 Pediatric gastroenterology, hepatology & nutrition Vol.9 No.1

윌슨병에서 용혈성 빈혈과 전격성 간부전이 동반되면 혈장교환술이나 간이식이 필수적이다. 저자들은 간염과 용혈위기가 동반된 전격성 윌슨병 환아에서 혈장교환술을 계속하였으나 호전을 보이지 않아 교환수혈을 시행한 결과 용혈위기를 극복하였다. 현재까지 약물치료와 혈장교환술에 뒤이은 간이식이 일차 치료로 되어 있지만, 전격성 간부전이 응급으로 간이식을 해야 할 만큼 심하지 않은 경우에는 혈장교환술후 교환수혈을 시도할 수 있을 것으로 생각한다. In case of Wilson's disease complicated with hemolytic anemia and fulminant hepatic failure; plasma exchange or liver transplantation should be considered. We report an 11 year-old male with fulminant Wilson's disease who developed hemolytic crisis. He was recovered by exchange transfusion after 6 times of plasma exchange.

심장 자기공명영상을 이용한 팔로사징 완전 교정술 후 우심실 기능에 대한 연구

장우성 ( Woo Sung Jang ),최희정 ( Hee Joung Choi ),이종민 ( Jong-min Lee ),김재범 ( Jae Bum Kim ),김재현 ( Jae Hyun Kim ),장재석 ( Jae Seok Jang ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.2

Background: We investigated the difference in right ventricle (RV) volume and ejection fraction (EF) according to the pulmonary valve (PV) annular extension technique during Tetralogy of Fallot (TOF) total correction. Methods: We divided patients who underwent the procedure from 1993 to 2003 into two groups according to PV extension technique (group I: PV annular extension, group II: no PV annular extension) during TOF total correction. We then analyzed the three segmental (RV inlet, trabecular and outlet) and whole RV volume and EF by cardiac magnetic resonance imaging (MRI). Results: Fourteen patients were included in this study (group I: 10 patients, group II: four patients; male: nine patients, female: five patients). Cardiac MRI was conducted after a 16.1 years TOF total correction follow-up period. There was no statistical difference in RV segmental volume index or EF between groups (all p>0.05). Moreover, the total RV volume index and EF did not differ significantly between groups (all p>0.05). Conclusion: The RV volume and EF of the PV annular extension group did not differ from that of the PV annular extension group. Thus, PV annular preservation technique did not show the surgical advantage compared to PV annular extension technique in this study.

초등학교 4학년이 지각한 부모의 강요, 자율성 지지가 학업열의에 미치는 영향: 스마트폰 의존의 매개효과

유계환 ( Yoo¸ Kae-hwan ),최희정 ( Choi¸ Hee-joung ) 한국아동교육학회 2021 아동교육 Vol.30 No.3

본 연구는 코로나19 시대를 살아가는 아동들이 비대면 수업으로 인하여 학업에 대한 열의가 떨어지는 상황에서 가정에서의 부모의 양육태도가 학업열의에 어떻게 작용을 하는지 알아보기 위하여 진행되었다. 특히 비대면 수업으로 인하여 아동들이 스마트기기를 더욱 많이 사용하게 됨에 따라 자연스럽게 스마트폰 의존에 빠져들게 된다. 이때 부모의 양육태도와 학업열의 사이에서 스마트폰 의존의 매개효과 있는지 알아보고자 하였다. 이를 위하여 한국청소년정책연구원에서 수행한 한국아동·청소년패널조사 2018 (KYCPS 2018)의 초등학교 4학년 1차년도 자료를 사용하였다. 연구결과는 다음과 같다. 첫째, 각 변인들 사이에는 유의한 상관관계가 있음을 확인하였다. 둘째, 부모의 강요는 학업열의에 직접적으로 영향을 주지는 않지만, 스마트폰 의존에 영향을 주어, 학업열의에 영향을 주는 것을 확인하였다. 셋째, 자율성을 지지하는 부모의 양육태도는 학업열의에 직접적인 영향을 주기도 하지만, 스마트폰 의존에 영향을 주어, 학업열의에 영향을 주는 것을 확인하였다. 즉 스마트폰 의존이 학업열의에 영향을 줌에 있어서 강요적인 양육태도에 있어서는 완전매개를, 자율성지지에 있어서는 부분매개하고 있음을 확인하였다. 이를 통하여 자율성을 인정하는 자율성지지와 자율성을 인정하지 않는 강요 부모가 초등학교 고학년이 시작되는 시기인 4학년 시기 자녀에 대한 양육태도의 형태에 따라 스마트폰 사용에 대한 통제력을 길러줄 수 있으며, 이를 통하여 학업열의에 영향을 줄 수 있다는 것을 알게 되었다. 본 연구를 통하여 부모의 양육태도에 있어서 스마트폰에 의존하는 태도와 학업열의에 미치는 태도를 확인함으로써, 초등학교 고학년 시기를 맞이하는 자녀에게 어떠한 양육태도를 가져야하는지에 대하여 확인하였으며, 이를 부모교육에 있어서 적절하게 적용할 필요성을 확인하였다. This study was conducted to find out how parental attitudes at home affect academic enthusiasm at a time when children living in the covid-19 era are less enthusiastic about their studies due to non-face-to-face classes. In particular, as children use smart devices more often due to non-face-to-face classes, they naturally fall into smartphone dependence. At this time, he wanted to see if there was a mediation effect of smartphone dependence between parental pressure and autonomy support and academic enthusiasm. For this purpose, the first-year data of the fourth grade of elementary school was used in the Korean Children and Youth Panel Survey 2018 (KYCPS 2018) conducted by the Korea Youth Policy Institute. The results of the study are as follows. First, we confirm that there is a significant correlation between each speaker. Second, parental pressure does not directly affect academic enthusiasm, but it does affect smartphone dependence, confirming that it affects academic enthusiasm. Third, parenting autonomy support also directly affects academic enthusiasm, but also influences smartphone dependence, confirming that it affects academic enthusiasm. In other words, it is confirmed that smartphone dependence is fully marketed in terms of forced parenting and partially in support of autonomy. Through this, it was discovered that parents who acknowledge autonomy and who do not acknowledge autonomy can develop control over the use of smartphones depending on the type of parenting attitude of their children during the 4th grade, which can affect their academic enthusiasm. Through this study, we identified attitudes that depend on smartphones and attitudes that affect academic enthusiasm in the parenting attitude of parents and identified the need to apply them appropriately to parents' education.

소아 크룹 환자들의 원인 바이러스에 따른 임상 양상과 입원 경과 비교

김가은 ( Ga Eun Kim ),신석원 ( Suk Won Shin ),최희정 ( Hee Joung Choi ),최보금 ( Bo Geum Choi ) 대한천식알레르기학회(구 대한알레르기학회) 2018 Allergy Asthma & Respiratory Disease Vol.6 No.6

Purpose: We evaluated the clinical features of croup in children according to viral etiology. Methods: This study enrolled pediatric patients with croup, who showed positive results on respiratory virus reverse transcriptase polymerase chain reaction performed between January 2012 and December 2017. We retrospectively reviewed the medical records. Results: A total of 179 patients (119 boys and 60 girls) were enrolled with the mean age of 18.9±14.7 months. The viruses commonly identified were parainfluenza, respiratory syncytial virus, rhinovirus, and influenza. Among these 4 viruses, patients with rhinovirus infection showed significantly shorter fever and admission durations. Patients with parainfluenza infection showed significantly lower incidences of epinephrine nebulization and patients with influenza infections showed significantly higher incidences of steroid treatment. Conclusion: Clinical manifestations of croup differ according to causative viruses. Further studies should be conducted to evaluate the severity and prognosis of croup according to viral etiology. (Allergy Asthma Respir Dis 2018;6:290-294)

소아에서의 기립성 저혈압과 기립성 체위성 빈맥증후군: 임상 양상 및 신경생리검사 비교

김윤겸(Yun Kyum Kim),박지현(Ji Hyun Park),최희정(Hee Joung Choi),김준식(Joon Sik Kim) 대한소아신경학회 2017 대한소아신경학회지 Vol.25 No.3

Purpose: The clinical characteristics and neuropsychological tests of orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS) in children were compared. Methods: From August 2011 to April 2015, we enrolled patients who visited hospital with dizziness or syncope. According to the results of head-up tilt test (HUTT), the patients were classified into 4 groups; OH group, POTS group, normal group I who had no orthostatic symptom during HUTT, and normal group II who had orthostatic symptom during HUTT. Results: Eighty-eight patients were enrolled with 11(12.5%) in OH group, 13(14.7%) in POTS group, 49(55.7%) in normal group I and 15(17.0%) in the normal group II. During HUTT, the temporal changes of systolic, diastolic, and mean blood pressure of OH group were significantly different from those of POTS group, normal group I, and normal group II. Heart rate changes after tilt showed increase trend in all 4 groups and there was no significant different between OH and POTS group. In normal group II, the temporal changes of diastolic and mean blood pressure were similar to those in POTS group and were significantly different from normal group I. In the autonomic nervous system test, the heart rate response to deep breathing (HRDB) was significantly different between normal group I and II. Conclusions: In pediatric OH patients, heart rate may be increased with blood pressure fall. And if orthostatic symptoms are associated with HUTT, we should not exclude OI even if the test result do not meet the criteria for diagnosis.

봄, 여름에 호발하는 소아 호흡기 바이러스 감염: 보카바이러스를 중심으로 한 임상 양상 비교

곽광진 ( Kwang Jin Kwak ),김여향 ( Yeo Hyang Kim ),최희정 ( Hee Joung Choi ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.6

Purpose: We evaluated the clinical characteristics of respiratory viruses that were frequently found in children during spring/summer, namely, human bocavirus (hBoV), human metapneumovirus (hMPV), parainfluenza virus (PIV), and human rhinovirus (hRV). Methods: This study enrolled patients with acute lower respiratory infection in whom respiratory virus reverse transcriptase polymerase chain reaction was performed between March 2013 and August of 2013. We retrospectively reviewed the medical records to collect the patients’ data. Results: A total of 96 patients were enrolled and divided into 5 categories: hBoV in 19 patients (19.8%), hMPV in 18 patients (18.8%), PIV in 16 patients (16.7%), hRV in 20 patients (20.8%), and negative result in 23 patients (24.0%). The mean age of the patients was 8.2±5.9 months (median, 7.5 months; range, 1-24 months), and the male-to-female ratio was 1.1:1. The most common diagnoses were acute bronchiolitis (62.5%) and pneumonia (30.2%). Compared to other patients, those with hBoV were older (12.3±4.9 months, P=0.001) and more frequently diagnosed with acute bronchiolitis (P=0.005). In addition, they showed higher incidences of tachypnea and rales (P=0.039 and P=0.035, respectively), and were more frequently treated with oxygen and systemic steroids (P=0.044 and P=0.001, respectively) than the other patients. Conclusion: We compared respiratory viruses in children during spring/summer and found that hBoV may have more severe clinical manifestations than other viruses. (Allergy Asthma Respir Dis 2015;3:410-416)

기관지폐이형성증을 가진 미숙아 환아에서 하기도 호흡기 감염의 임상 양상

이나현 ( Na Hyun Lee ),김세진 ( Se Jin Kim ),최희정 ( Hee Joung Choi ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.2

Purpose: We evaluated the clinical characteristics of lower respiratory infections of preterm children with bronchopulmonary dysplasia (BPD) and compared them between those with and without lower respiratory infections that of preterm patients without BPD. Methods: This study enrolled preterm patients under 2 years old, who admitted with acute lower respiratory infection from March 2014 to May 2016. The patients were divided into 2 groups according to BPD, and we retrospectively reviewed their medical records. Results: A total of 71 patients (106 cases) were enrolled; the BPD group consisited of 29 patients (54 cases) and the control group 42 patients (52 cases). Compared to the patients in the control group, those in the BPD group were older (P=0.001), had lower gestational age and birth weight (P<0.001), and showed more frequent readmission in hospital (P=0.017). The most common causative virus was human rhinovirus (hRV) in the BPD group, whereas respiratory syncytial virus (RSV) in the control group. The patients in the BPD group showed a higher incidence of tachypnea, decreased aeration, and chest retraction (P<0.001, P=0.009, and P=0.026, respectively), a higher respiratory symptom score (P=0.011), a longer duration of cough and wheezy sounds (P=0.004 and P=0.009, respectively), and higher incidence and longer duration of treatment with oxygen, and mechanical ventilator support (P=0.016 and P=0.017, respectively) than those in the control group. In the BPD group, the patients with RSV showed a higher incidence of tachypnea and rales (P=0.033 and P=0.033, respectively) than those with hRV. Conclusion: The preterm children with BPD may have more severe clinical manifestations than those without. (Allergy Asthma Respir Dis 2017:5:92-98)

젊은 여자에서 발병한 간질성 신염 포도막염 증후군 1예

김수민 ( Soo Min Kim ),송재욱 ( Jae Uk Song ),최이령 ( E Ryoung Choi ),최희정 ( Hee Joung Choi ),이정은 ( Jung Eun Lee ),권기영 ( Ghee Young Kwon ),허우성 ( Woo Seong Huh ),김윤구 ( Yoon Goo Kim ),김대중 ( Dae Joong Kim ),오하영 ( 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.5

We report a case of adult-onset tubulointerstitial nephritis and uveitis syndrome with Fanconi syndrome. A 31-year-woman presented with fever, anorexia, nausea, general weakness and weight loss for two months. Her initial laboratory findings showed anemia, high serum creatinine, hypouricemia, hypophosphatemia, hypokalemia, glucosuria, and proteinuria. She was diagnosed as having acute tubulointerstitial nephritis by renal biopsy. The etiology of tubulointerstitial nephritis was unclear. She was treated with systemic corticosteroid. Six months later and while the patient was still on systemic corticosteroid (Deflazacort 36 mg), bilateral uveitis developed. Renal function was recovered by systemic corticosteroid and mycophenolic acid. But ocular symptoms relapsed twice despite systemic corticosteroid treatment. The ocular symptoms improved after topical ophthalmic steroid drops and injection. Tubulointerstitial nephritis and uveitis syndrome should be considered in the differential diagnosis of the unexplained tubulointerstitial nephritis. And the need of the steroid treatment also should be considered in the case of adult-onset.