Controlled Atrial Fibrillation after Pulmonary Vein Stenting

When there is no pulmonary vein reconnection after catheter ablation for atrial fibrillation, patients can experience recurrence of atrial fibrillation without clear evidence of non-pulmonary vein foci. We describe a patient with significant pulmonary vein stenosis and recurrent atrial fibrillation after four ablation procedures. After successful pulmonary vein stenting, the symptoms were resolved, and sinus rhythm was maintained for 2 years without treatment with antiarrhythmic medication. We believe pulmonary vein stenting potentially controlled atrial fibrillation by providing pulmonary vein pressure relief or by compressing the epicardial triggers occurring at the pulmonary vein ostium.ope

Etiology and clinical feature of oral allergy syndrome in children

Purpose: Oral allergy syndrome (OAS) is a unique allergic reaction to fresh fruits or vegetables, which is caused by cross-reactivity between foods and pollens. This study was conducted to investigate the clinical feature of OAS and relevant pollen allergens as well as the association between them in Korean children. Methods: This single-center study included 290 children who were sensitized to pollens at Severance Hospital, and the clinical characteristics of children with and without OAS were compared. A multicenter study included 97 children who were diagnosed with OAS at 3 hospitals between January 2008 and June 2014. The details of clinical features were collected by retrospective medical record reviews using a standardized case report form. The relevant pollen allergens were identified by skin prick tests and/or serum specific IgE levels. Results: The most commonly sensitized allergen was Japanese hop in pollen-sensitized children. Children with OAS were most commonly sensitized to birch and oak, and 12.4% of the pollen-sensitized children had OAS in the single center. The number of children who were newly diagnosed with OAS has increased over the past 7 years. The most common causative food of OAS was apple. More than 60% of patients with OAS had oral allergic reactions to multiple foods. Conclusion: OAS may be relatively common in pollen-sensitized children. OAS should be considered in children with allergic disease and sensitization to pollens.ope

A Case of Congenital Disseminated Malignant Rhabdoid Tumor of the Soft Tissue in Neonate

Malignant rhabdoid tumor (MRT) was first described as a “rhabdomyosarcomatoid” variant of Wilms tumor, but was later identified as a distinct entity. MRTs are extremely rare and highly aggressive neoplasm with poor outcome, occurring mostly in kidneys and central nervous system, less frequently in extrarenal sites. MRTs are referred to as “congenital” when it is diagnosed at or immediately after birth. There are few reports about congenital disseminated MRT at birth. We report a case of congenital malignant rhabdoid tumor presenting as a soft tissue mass in the right arm at birth although the autopsy revealed the systemic disseminated tumors through the whole body with typical microscopic findingsope

Utility of tools for the assessment of asthma control in childhood asthma

Purpose : The goal of asthma control is to maintain well-controlled state. In this study, we investigated whether childhood asthma control test (C-ACT) may reflect lung function and whether fractional exhaled nitric oxide (FeNO) can be used to improve the accuracy of C-ACT in reflecting the asthma control level. Methods : We reviewed the medical records of 155 patients with asthma underwent lung function tests and C-ACT upon visiting our outpatient clinic. We compared lung function test results according to the C-ACT score stratified by atopy and also examined FeNO according to C-ACT and the Global Initiative for Asthma (GINA) guidelines. The diagnostic accuracy of well-controlled asthma by C-ACT, FeNO, and C-ACT+FeNO was examined. We also calculated the cutoff value of FeNO and C-ACT for well-controlled asthma. Results : Peak expiratory flow (PEF) showed a significant correlation with the C-ACT score. Stratified by atopy, PEF, and forced expiration in one second (FEV1) showed significant correlations with the C-ACT score in the atopic asthma group. There was no difference in FeNO between subjects with C-ACT≥20 and <20, but FeNO was significantly higher in the uncontrolled asthma according to the GINA guidelines. The diagnostic accuracy of well-controlled asthma was higher when FeNO was combined with the C-ACT score than C-ACT or FeNO. Our study showed that the cutoff values of C-ACT and FeNO 19 and 18.3 ppb (parts per billion), respectively, for well-controlled asthma. Conclusion : C-ACT showed a significant correlation with PEF, and atopic asthma group showed significant correlations with PEF and FEV1. A combination of C-ACT with FeNO might reflect asthma control status more accurately.ope

Relationship Between Serum Interleukin-17F Level and Severity of Atopic Dermatitis in Children

Background: Recent discovery of the Th17 pathway is providing new opportunities for understanding chronic immune-mediated diseases. The Th17 pathway has been historically associated with chronic inflammatory diseases such as psoriasis, multiple sclerosis, and rheumatoid arthritis. Among Th17 cytokines, pathogenic roles of IL-17A and IL-17F in asthma have been well described. Recently, the number of peripheral blood Th17 cells was found to correlate with disease severity in patients with atopic dermatitis (AD). This study aimed to investigate serum IL-17F levels in children with AD and to correlate this with severity of the disease. Methods: Enzyme-linked immunosorbent assay was used to measure IL-17F levels in the sera of 228 patients with AD and 62 control children. The SCORing Atopic Dermatitis (SCORAD) tool was used to determine the severity of disease. Results: The mean serum level of IL-17F in children with AD was significantly higher than that in the control group (p<0.05) Serum IL-17F levels were also higher in patients with severe AD than in those with mild AD (p<0.001), and IL-17F levels and SCORAD scores were positively correlated (p<0.05). Conclusions: Serum IL-17F level might be a useful marker in children with AD.ope

Heterogeneity of asthma according to systemic inflammatory pattern in children

Purpose: Asthma is a chronic airway inflammation. We evaluated whether systemic inflammatory patterns could reflect the nature of airway inflammation. We assessed characteristics of asthma according to systemic inflammatory patterns. Methods: A total of 413 children with asthma were enrolled in the study. Four systemic inflammatory patterns were classified according to eosinophil and neutrophil counts in peripheral blood. Children with neutrophil count≥5,000/μL were defined as the NEUhi group, those with neutrophil count <2,720/μL as the NEUlo group. The intermediate group with neutrophil count between 2,720/μL and 5,000/uL was excluded from the study. Children with eosinophil≥650/μL were defined as the EOShi group, those with eosinophil count<240/μL as the EOSlo group. The remaining patients were excluded from the study. The characteristics of asthma include pulmonary function test results, bronchodilator response, airway hyperresponsiveness, and atopy. Results: The EOShi group had a lower PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second [FEV1]), a lower FEV1, and a higher immunoglobulin E level rather than the EOSlo groups, although there were no significant differences between the NEUhi and NEUlo groups. The eosinophil percentages of the induced sputum samples were higher in the EOShi group than the EOSlo group and correlated with blood eosinophil counts. Conclusion: Eosinophilic inflammation was related to characteristics of asthma and sputum eosinophils. However, neutrophilic inflammation reflected neither asthma features, sputum neutrophils, nor eosinophilic inflammation. Further studies on blood neutrophils involving asthma phenotypes in terms of more specific characteristics of asthma should be needed in children.ope

Long-Term Prognosis of Patients with an Implantable Cardioverter-Defibrillator in Korea

PURPOSE: The objective of this study was to elucidate the long-term prognosis of patients with implantable cardioverter-defibrillators (ICDs) in Korea. MATERIALS AND METHODS: We enrolled 405 patients (age, 57.7±16.7 years; 311 men) who had undergone ICD implantation. The patients were divided into three groups: heart failure (HF) and ICD for primary (group 1, n=118) and secondary prevention (group 2, n=93) and non-HF (group 3, n=194). We compared appropriate and inappropriate ICD therapy delivery among the groups and between high- (heart rate ≥200 /min) and low-rate (<200 /min) ICD therapy zones. RESULTS: During the follow-up period (58.9±49.8 months), the annual appropriate ICD therapy rate was higher in group 2 (10.4%) than in groups 1 and 3 (6.1% and 5.9%, respectively, p<0.001). There were no significant differences in annual inappropriate ICD therapy rate among the three groups. In group 1, the annual appropriate ICD therapy rate was significantly lower in patients with a high-rate versus a low-rate therapy zone (4.5% and 9.6%, respectively, p=0.026). In group 3, the annual inappropriate ICD therapy rate was significantly lower in patients with a high-rate versus a low-rate therapy zone (3.1% and 4.0%, respectively, p=0.048). CONCLUSION: Appropriate ICD therapy rates are not low in Korean patients with ICD, relative to prior large-scale studies in Western countries. Appropriate and inappropriate ICD therapy could be reduced by a high-rate therapy zone in patients with HF and ICD for primary prevention, as well as non-HF patients, respectively.ope

Feasibility and safety of transcatheter closure of patent ductus arteriosus in small children weighing 10kg or less

의학과/석사목 적: 경피적 심도자술을 통한 중재적 폐쇄술은 현재 동맥관 개존의 표준적 치료로 시행되고 있다. 지속적인 기술의 발전과 시술 경험의 축적으로 성공률이 향상되었으나, 시술과 연관된 합병증은 여전히 보고되고 있으며, 특히 체중이 작은 영아에서 합병증 발생 비율이 높다. 이에 본 연구는 이전의 연구들보다 많은 환자를 대상으로 한 시술 결과를 분석하여, 체중이 10kg 이하인 소아에서 적절한 치료에 도움이 되고자 하였다.방 법: 2003년 1월부터 2009년 12월까지 연세대학교 세브란스병원 소아심장과에서 동맥관 개존을 진단받고 경피적 심도자술을 통한 중재적 폐쇄술을 받은 환아 115명을 대상으로 하였다.결 과: 대상 환자의 평균 나이는 9.1 ± 5.9개월이고, 평균 체중은 7.6 ± 1.8kg 이며, 동맥관의 평균 최소직경은 3.6 ± 1.8mm 이었다. 전체 115명의 대상 환자 중 114명의 환자에서 시술이 성공적으로 시행되었다. (성공률 99%) 실패한 1명의 환자는 시술 직후 기구의 위치가 불안정하여, 색전의 가능성이 높아 제거한 경우였다. 시술이 성공한 114명의 환자 중 1명은 시술 3년 후까지 미세한 단락이 관찰되었다. 경도의 하행 대동맥 협착이 관찰된 환자는 2명이었고, 그 중 1명은 진행하는 소견을 보여 시술 후 3개월에 경피적 혈관 성형술을 시행하였다. 3명의 환자에서 경도의 폐동맥 협착이 보였다. 그 외 시술과 연관된 혈관 손상 및 용혈 현상, 그리고 다량 출혈과 같은 합병증은 관찰 되지 않았다.결 론: 10kg 이하 소아에서 경피적 심도자술을 통한 동맥관 개존의 중재적 폐쇄술은 성공률이 99% 로, 높은 성공률 및 안전성을 보여 주었다. 따라서 체중이 10kg 이하인 소아 환자의 동맥관 개존에 대한 경피적 심도자술을 통한 중재적 폐쇄술은 향후 안전한 선택적 치료 방법으로 적용될 수 있을 것이다.ope

Parenting Experiences and Child-rearing Values of Women Who Have Experienced Korean War in Their Childhood: On the Perspective of the Life Course Narrative Study

학위논문 (석사)-- 서울대학교 대학원 : 아동가족학과, 2015. 2. 이순형.이 연구는 한국전쟁이라는 위기사건이 개인의 삶과 양육에 미친 영향을 알아보고자 하였다. 특히, 아동기의 전쟁 경험이 어떠하였는지, 그것이 다른 발달 시기의 경험과는 어떠한 차이가 있는지를 살펴보고자 하였다. 이를 위해 발달 시기별(아동기, 학령기, 청소년기, 초기 성인기) 전쟁 경험과 당시의 양육경험을 살펴보았다. 나아가 이들의 자녀 양육 경험과 가치를 과거 생애경험, 특히 한국전쟁 경험과 관련시켜 파악하고자 하였다. 마지막으로, 자녀들의 양육 경험과 현세대의 양육을 한국전쟁을 겪은 이들의 관점에서 어떻게 평가하는지를 알아보고자 하였다. 이를 위해 생태학적 체계이론(PPCT모델)과 생애 과정 관점을 사용하였다. 이를 토대로 전쟁이라는 역사적 사건이 개인과 개인을 둘러싼 생태체계에 어떠한 영향을 미쳤는지를 살펴보고 그 영향이 전 생애에 걸쳐 어떻게 지속되고 있는지를 알아보고자 하였다. 이들이 생애에 걸쳐 경험한 양육을 전쟁 경험과 분리시키지 않고, 가족과 사회 등 다양한 맥락의 영향을 살펴보고자 한 것이다. 이러한 목적으로 이 연구는 다음과 같은 연구문제를 설정하였다. 첫째, 한국전쟁 경험은 어떠하였으며, 전쟁시기의 양육은 어떠한가? 둘째, 한국전쟁을 경험한 세대가 한 양육은 어떠한가? 셋째, 한국전쟁을 경험한 세대가 바라보는 양육은 어떠한가? 이상의 연구 문제를 위해, 각기 다른 발달 시기에 전쟁을 경험한 8명의 여성 노인을 면접하였다. 생애 구술 방법을 사용하여 이들의 생애 이야기를 수집하였고 범주 분석을 거쳐 개인적 경험에 드러난 사회적 맥락을 분석하였다. 연구문제에 대한 주요 결과는 다음과 같다. 첫째, 전쟁 경험은 개인이 극복하기 힘든 위기 경험으로, 개인의 시간에 따라 변화하는 역할이나 지위의 전환이 아닌 외부적 사건으로 인해 생태학적 전환을 경험하도록 했다. 이러한 생태학적 전환은 개인이 어떠한 발달 시기에 전쟁과 조우했는지에 따라 다르게 의미화 되었다. 또한 같은 발달 단계에 있었다 하더라도 개인의 체험에 따라 전쟁의 영향을 다르게 해석하였다. 전쟁 당시 폭력적인 경험이나 가족원의 상실에 노출되었는지, 그러한 위기에서 가족들이 완충제의 역할을 하였는지에 따라 이들이 전쟁을 의미화 하는데 차이가 있었으며 거주 지역과 계층에 따라서도 전쟁 체험의 차이가 있었다. 둘째, 이들이 받은 양육은 아버지의 부재, 두 얼굴의 어머니, 돌봄 공백의 가족주의적 대응으로 나타났다. 이를 통해 전쟁 이후 가치관의 변화 속에서도 전통적인 가족주의 가치관이 계속 지속되었음을 알 수 있었다. 또한 전통과 근대가 교차하던 당시의 어머니의 모습은 이들에게 전통적 가치의 수호자 이기도 하였고 새로운 가치관의 창출자이기도 하였으며 전통적 가치관과 새로운 가치관 사이에서 표류하는 모습으로 해석되었다. 셋째, 전쟁 체험과 원가족 체험은 자녀를 양육하는 데 반영이 되었다. 전쟁 체험은 이들이 자녀를 기르는 데 있어 생존과 건강을 중시하고, 교육 투자를 강조하고, 사회적 지지를 제공하는 것에 영향을 미쳤다. 새로운 가족을 만들고, 자녀를 통해 자신의 한(恨)을 보상하는 양육은 이들의 적응에 중요하게 작용했다. 원가족 체험은 행위 양식의 연장, 반동, 보상이라는 방식으로 이들의 양육 경험과 가치에 영향을 미쳤지만, 자식들의 안정된 삶을 통해 자신의 어머니로서의 삶을 평가하고 보상한다는 점에서는 세 가지 방식이 비슷한 구조를 보이고 있었다. 넷째, 이들이 손자녀 양육과 현세대 양육을 바라보는 데 전쟁 체험, 자신의 원가족 체험, 자신의 양육 체험이 영향을 미쳤다. 또한 이들이 살아오면서 내재화되었던 가치는 이들이 손자녀 양육과 현 세대 양육을 바라보는 렌즈가 되고 있었다. 이들에게 손자녀 양육의 의미는 부모세대가 못해준 것을 해주는 것, 자녀를 위해서 당연히 해 주는 것, 돌봄의 공백을 가족인 자신이 채워주는 것이었다. 즉, 가족공동체의 안정과 유지를 위해 마땅히 수행해야 할 중요한 자기 역할인 것이다. 또한 손자녀의 교육적 성취는 전쟁으로 인한 자신의 불리한 생애 경험을 보상해주는 것으로 해석되었다. 또한 현세대의 자녀 양육에 대해서는 저출산, 인성 교육의 부재, 개인주의 가치관의 만연 등을 염려하였다. 이러한 결과는 이들의 가치관에 전쟁이 지속적으로 영향을 미치고 있다는 것을 의미한다. 전쟁을 통해 이들은 가족원의 상실을 직접적으로 체험하기도 했으며, 직접 체험하지 않았더라도 불안감과 위기감을 가질 수밖에 없었다. 또한 전쟁을 겪으면서 가족은 응집되었고, 아버지의 빈자리를 어머니가 채우고, 어머니의 빈자리를 손위 형제들이 채우는 등 가족은 이들의 결핍과 상실, 외상을 완충 시켜주는 완충기제로서 작용하였다. 뿐만 아니라, 나라에 대한 애착이나, 이웃들 간의 서로 돕는 상부상조의 가치가 내재화 되었고 때문에 가족, 이웃, 국가 보다 개인이 중요한 개인주의적 가치관에 반감을 가지게 된 것이라고 짐작해볼 수 있다. 이는 이들이 과거 전쟁 경험에 대한 반추의 과정을 통해 현재 삶을 바라보고 있음을 보여준다. 이 연구는 전쟁 당시 아동기였던 이들을 대상으로 살펴본 연구나 당시의 양육 경험을 살핀 연구가 없다는 점에서 의의가 있다. 따라서 전쟁이 아동에게 미치는 영향이 어떠한지, 전쟁 상황에서 아동은 이들을 둘러싼 환경과 어떻게 상호작용하는지를 알아보는 데 도움을 줄 수 있을 것이다. 또한 외상 경험에도 불구하고 그를 극복하고 살아온 이들의 이야기를 통해 적응유연성의 자원으로서 양육의 의미를 되새겨 볼 수 있었다. 마지막으로 이 연구는 현재 우리의 자녀 양육을 지난 세대의 관점에서 돌아보고 우리가 놓치고 있는 가치가 무엇인지를 알아보았다. 이 연구를 통해 우리가 가지고 있던, 그리고 전쟁이라는 위기 상황에서도 놓치지 않고 있던 바람직한 양육의 가치들을 발견하여 그것을 키워나간다면 양육 가치의 차이로 인한 세대 간의 갈등이나 단절을 해결하는 데 도움이 될 수 있을 것이다.The purpose of this study was to investigate how Korean War has influenced the lives of individuals and their child-rearing experiences. Particularly, this study aimed to show the unique aspects of parenting practices and war experiences of the children during Korean War by examining early developmental phases including early childhood, pre-adolescence, adolescence, and young adulthood. Furthermore, this study was to investigate and how the participants were raised in terms of their personal experience during Korean War. Lastly, this study examined how the war-experienced participants view their own child-rearing experience as appose to those of the current generations. The ecological system theory and the life course perspective were selected to examine (1)how a tragic event such as war have influenced individuals ecological systems, and (2)how these ecological changes remained its significance through life course of the participants. The study scrutinized the whole experiences of child-rearing practices over the life course of participants, and used it as a significant mean to understand the family and social context in war time. A total of eight female participants were interviewed. The life course narrative technique was used in order to record their stories about their childhood, and then the narrative were recorded, categorized and analyzed to find out the specific social contexts within their personal experiences. The major findings of the study are as follows. Firstly, an individual cannot fully recover from a war experience because it is such a dreadful event that changed the whole ecological system of each individual. This dramatic transition was not simply created by general or chronical changes in human livesit was due to a powerful external force that created tremendous changes in families and society. These ecological transitions were analyzed as significant since the individuals interfaced with war environment in their own developmental stages. Sometimes however, the individuals in the same developmental stages have analyzed their experiences differently, this is because each participant had different lived-experience of their own. The significance of Korean War had different meanings and consequences to each individual according to their community and social statussome individuals were exposed to more violence than others, some experienced loss of the immediate family, and some were protected by families who acted as buffer during the war time. Secondly, the aspects of parenting represented absent of fathers, two-faced mothers, and family-oriented reaction in the absent of immediate parenting. Through these, family oriented culture was remained and carried down as a traditional value even after the war time. Also, mothers played role as both a guidance of traditions and a creator of new values in those times when modernism was arising after the war. As a result, the mothers were perceived as ones who are drifting between the old and the new. Thirdly, the war and the experiencing family-of-origin have reflected child-rearing practices of the participants. The war experiences have influenced them to emphasize survival and health to their offspring. They also learned the importance of education and social support through the war experience while their sorrow regrets were comforted through creating their own family and child-rearing practices. The experience in family-of-origin have influenced and formed three significant behavior patterns among the participants: prolongation, retroaction, and compensation. However, these three values have affected the participants equally in terms of evaluating and rewarding their own lives though the childrens successful settlement. Fourthly, the experiences of war, family-of-origin, and the child rearing practices have affected their views on rearing grandchildren and current generations parenting practices. Furthermore, the internalized family-oriented values such as unconditional caring and offering an extra help in raising children have become a lens to see parenting practices in current generation. In other words, the participants recognized the needs of their family and saw themselves as the ones who fill-in those incomplete spots in order to maintain the goodness in family. The participants recognized low birth rate, extreme individualism, and absent of character education as some of the down sides of the current generations child-rearing practices. The result revealed that the war has been affecting the values of the participants consistently. Due to the war, the participants suffered through anxiety and vulnerability while actually experiencing loss of family members. And this kind of experience made the families to bond with each other and act as a buffer in situations where they experienced traumatic events such as loss and deprivation due to death of family members. These values have been extended and influenced on patriotism, and community relationships. The meanings of family, neighborhood, and country became more important as appose to individualistic ideology for participants who have experienced Korean War. It is assumed that the participants are looking at the lives of their own through ruminating the war experiences. This study is significant because there is no previous studies that investigated childhood experience or child-rearing experience during Korean War. Therefore, this study contributed in finding various effects of war on children, and providing resources on how children have interacted with this particular environment during Korean War. This study also tried to view current child-rearing practices from the past generations perspective, aiming to find out what we should learn from our traditional values. The study suggests that finding out those precious child-rearing values that survived through war may help us to find the keys to solve conflicts and open the doors of communication between the generations.Ⅰ. 서론 1 1. 문제제기 1 2. 연구목적 및 연구문제 5 Ⅱ. 이론적 배경 7 1. 생태학적 이론 8 1) 생태체계이론 8 2) 생애과정관점 11 2. 양육 가치의 형성과 세대 간 전이 12 1) 원가족 양육 경험과 양육 가치의 형성 12 2) 양육 경험과 가치의 세대 간 전이 양상 13 3. 한국 전쟁과 양육 가치의 변화 15 1) 가족주의 가치관의 변화와 지속 15 2) 자녀성공주의의 대두 16 3) 남녀차별의 가치와 남아선호사상의 지속 17 Ⅲ. 연구방법 및 절차 19 1. 연구 참여자 19 2. 연구 방법 및 절차 24 1) 연구 방법 24 2) 자료의 수집과 분석 25 Ⅳ. 전쟁 체험과 내가 받은 양육 28 1. 전쟁 체험 28 1) 공통의 기억: 생태학적 전환 28 2) 전쟁 체험에 대한 기억의 차이 36 3) 전쟁 체험의 의미화 55 2. 내가 받은 양육 56 1) 전쟁 시기 양육 경험 56 2) 어머니 양육에 대한 의미화 64 Ⅴ. 양육 가치의 형성과 내가 한 양육 71 1. 양육가치의 형성: 전쟁 체험의 영향 71 1) 생존과 건강 71 2) 교육투자 74 3) 사회적 지지 79 2. 내가 한 양육: 원가족 체험의 영향 80 1) 행위양식의 연장: 엄마처럼 81 2) 행위양식의 반동: 엄마랑 다르게 85 3) 행위양식의 보상: 엄마보다 87 Ⅵ. 내가 바라본 양육 90 1. 손자녀 양육 90 1) 돌봄 공백의 가족주의적 대응 90 2) 희생에 대한 보상 92 3) 두 마음의 어머니: 이중적 행위양식 93 2. 현세대 양육 평가 95 1) 저출산에 대한 염려 95 2) 인성 교육의 부재에 대한 염려 96 3) 개인주의적 가치관에 대한 염려 98 Ⅵ. 결론 및 논의 100 1. 연구의 결론 100 2. 의의와 한계 103 1) 연구의 의의 103 2) 연구의 한계 107 3. 연구자의 해석학적 순환 108 참고문헌 112 부록 120 Abstract 124Maste

생산직 미혼 여성노동자의 주변적 지위에 관한 연구

학위논문(석사)--서울대학교 대학원 :인류학과 인류학전공,1995.Maste