소아청소년 염증성 장질환의 치료

김경모,Kim, Kyung Mo 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.suppl2

The incidence of inflammatory bowel disease is increasing rapidly in Korea and one quarter of the new patients present in childhood. Crohn's disease and ulcerative colitis are incurable conditions associated with significant morbidity, therefore the focus of treatment in children should be to reduce or eliminate symptoms, optimize nutritional status and growth, prevent complications. This review will deal with the evidence supporting the treatments currently used in children with inflammatory bowel disease.

소아에서 둔상 후에 발생한 담도협착의 내시경적 치료 경험 1례

김경모,김성철,서동완,윤종현,Kim, Kyung-Mo,Kim, Seong-Chul,Seo, Dong-Wan,Yoon, Chong-Hyun 대한소아소화기영양학회 1998 Pediatric gastroenterology, hepatology & nutrition Vol.1 No.1

저자들은 복부 둔상 후에 발생한 담도 단독 협착을 보인 환아에서 수술적인 치료를 대신하여 내시경적 경비담도 배액술과 플라스틱 스텐트 삽입으로 증상의 호전과 2년의 추적관찰에서 재발을 보이지 않고 있는 1례를 경험하여 문헌고찰과 함께 보고하는 바이다. Isolated injury to the extrahepatic biliary tract following blunt abdominal trauma is rare, and there is little information especially in children regarding the endoscopic diagnosis and management of occult injury to the biliary tract. We experienced a 5-year-old boy who presented with jaundice 16 days after blunt abdominal trauma and was diagnosed as isolated distal common bile duct stricture by ultrasonography of abdomen. We could get more detailed information about the injury by endoscopic retrograde cholangiopancreatography. We could also manage this isolated common bile duct stricture successfully with endoscopic nasobiliary drainage and plastic stent insertion instead of surgical correction. There appeared to be no recurrence of stricture as evidenced by biochemical test and ultrasonography during 2 years of follow up.

소아에서 간기능 검사 이상 소견의 해석과 실제

김경모,Kim, Kyung Mo 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.suppl1

The causes of liver disease in children and abnormal liver function test are more diverse than those in adult. Therefore, the first step to evaluate the liver disease is the understanding the liver disease and interpreting the appropriate liver function test in children. The characteristics of each test and various conditions which we encounter in outpatients settings will be discussed in this article, especially focused on elevation of aminotransferase level without identifiable causes.

소아 간이식

김경모,Kim, Kyung Mo 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.8

신생아 담즙정체증의 원인질환 및 장기추적 예후인자에 관한 고찰

김경모,서정기,Kim, Kyung-Mo,Seo, Jeong-Kee 대한소아소화기영양학회 1999 Pediatric gastroenterology, hepatology & nutrition Vol.2 No.1

목 적: 신생아 담즙정체증은 소아과 소화기 영역에서 중요한 질환의 하나임에도 불구하고 원인 질환 및 장기추적 고찰에 대한 국내의 보고가 드문 실정이다. 따라서 저자들은 신생아 담즙정체증의 원인 및 추적조사시의 합병증 등의 임상적 고찰과 함께 예후인자를 분석하여 신생아 담즙정체증 환아의 진료에 도움을 주고자 본 연구를 시행하였다. 방 법: 1981년부터 1992년까지 12년간 신생아 혹은 초기 영아기에 발생한 담즙정체증으로 서울대학교 어린이병원 소아과에 입원하였던 190명을 대상으로 하였다. 담즙정체증의 원인질환, 추적조사시에 관찰된 합병증 및 사인, 특발성신생아간염과 담도폐쇄증의 초기의 임상적 차이점, 예후 및 예후 인자를 분석하였다. 결 과: 1) 담즙정체증의 원인질환은 190명에서 신생아 간염이 101례(53%), 간외담도계 질환이 84례(44%), 간내담도형성부전증이 5례(3%)이었다. 신생아간염은 특발성신생아간염이 77례(41%), 감염성 신생아 간염이 24례(12%)이었고, 간외담도질환은 담도폐쇄증이 79례(41%), 총수담관낭이 5례(3%)이었다. 2) 추적조사시에 관찰된 주요한 임상적 문제점은 지속적인 고열, 위장관출혈, 간성혼수, 복수 등이었다. 3) 담도폐쇄증 환아에서 지속적인 고열의 원인은 상행성담관염, 혹은 line-related sepsis가 58%이었고, 폐렴이 15%, 요로감염이 8%, 상기도 감염이 7%이었다. 4) 상행성담관염 혹은 line related sepsis의 원인균은 Escherichia coli가 28%로 가장 빈도가 많았고, Coagulase negative staphylococcus가 14%, Streptococcus pneumoniae, Klebsiela pneumoniae가 각각 10%, Enterococcus가 6%, Candida albicans가 4%이었다. 5) 주요한 사인은 간성혼수와 위장관출혈이었다. 6) 특발성신생아간염은 71%, 감염성 신생아간염은 75%의 환아에서 회복되었으며, 대부분 생후 12개월 이내, 주로 6개월 이내에 회복되었다. 미숙아, 초기의 간종대가 작은 경우, 초기 알부민치 높은 경우, 콜레스테롤치, ${\gamma}$-GT치, 빌리루빈치 및 AST치가 낮은 경우에서 예후가 양호하였다. 7) 담도폐쇄증 환아의 Kasai수술후의 5년 생존율은 40%이었고 사망의 대부분은 12개월 이내에 관찰되었다. 가장 중요한 예후인자는 수술시기이었고 수술시기가 12주 이전인 49%가 양호한 예후를 보인 반면에, 12주 이후인 경우는 12%이었다. 8) 담즙정체증의 초기 임상소견중 가장 중요한 예후인자는 원인질환이었다. 9) 특발성신생아간염과 담도폐쇄증 사이에서 차이를 보인 임상소견은 성별, 제태연령, 콜레스테롤 치 및 ${\gamma}$-GT치 이었다. 특발성신생아간염은 남아, 미숙아에서 호발하였고, 낮은 콜레스테롤치 및 ${\gamma}$-GT치를 보였다. 결 론: 우리나라에서 신생아 담즙정체증의 흔한 원인으로는 담도폐쇄증과 특발성신생아간염의 빈도가 가장 높았고, 이외에 감염성 신생아 간염, 총수담관낭, Alagille 증후군 등이었으며, 유전성, 대사성질환은 관찰되지 않았다. 신생아 담즙정체증에서 원인질환은 예후를 결정하는 가장 중요한 요인으로 원인질환에 대한 적절한 진단이 요구되며, 또한 상행성 담관염, 폐렴, 패혈증 등의 감염문제, 간성혼수, 위장관 출혈 등은 장기 추적시의 자주 발생하는 심각한 임상적 문제점으로서 이에 대한 적절한 치료대책이 요구된다고 하겠다. Purpose: The aim of the present study was to evaluate the long-term clinical profile including the underlying etioligy and the prognostic factors of the neonatal cholestasis. Method: We studied the 190 infants presented with neonatal cholestasis for the last 12 years (from 1981 to 1992). The underlying causes, clinical findings and long-term outcomes were evaluated. And the prognostic factors were also analyzed. Result: Underlying disease were neonatal hepatitis in 101 (idiopathic in 77 and infectious in 24), intrahepatic bile duct paucity in 5, biliary atresia in 79, choledochal cyst in 5. Metabolic disease was not observed in this study. The important clinical problems during follow-up were persistent high fever, gastrointestinal bleeding, hepatic encephalopathy and ascites. The main causes of the death were hepatic encephalopathy and gastrointestinal bleeding. While three fourth of infants with idiopathic and infectious neonatal hepatitis recovered usually within a year, five-year survival rate for biliary atresia was just 40%, the mortality observed usually within the first year after Kasai operation and prognostic factor was the time of operation. Underlying disease was the most important prognostic factor of neonatal cholestasis. Conclusion: This study showed that most common causes of neonatal cholestasis were biliary atresia and idiopathic neonatal hepatitis, infectious neonatal hepatitis, choledochal cyst and Alagille syndrome, but few neonatal cholestasis of genetic or metabolic liver disease was observed. The most important long-term prognostic factor of neonatal cholestasis was the underlying disease.

소아 간이식의 현재

김경모,Kim, Kyung-Mo 대한소아소화기영양학회 2007 Pediatric gastroenterology, hepatology & nutrition Vol.10 No.1

Outcome of liver transplantation for children with end liver disease has been improved markedly during last two decades. Improvement of immunosuppressive agent and its strategy to use in children, development of innovative surgical technique, and better understanding of the course of liver transplantation attributed to better outcome of pediatric liver transplantation. Therefore this review article will focus on the problems which can occur during pre- and post-transplantation period, current strategy to use immunosuppressive agent for the better understanding of pediatrician who is not involved in transplantation but takes care of the children pre- and postoperatively.

기능창을 이용한 강건설계법

김경모(Kyung-Mo Kim) 한국기계가공학회 2008 한국기계가공학회지 Vol.7 No.1

The operating window method is a novel approach in quality improvement. But it has not received deserved attention in academic research. If a critical factor for competing failure modes can be identified, the probability of failure can be reduced by widening the operating window of this factor. Traditional SN ratio for the operating window advocated by Taguchi has a critical shortcoming, which has been derived under the assumption that failure rates are determined by the operating window factor only. A new metric for robustness is given for the operating window method, which has relaxed the restrictive assumption of Taguchi's SN ratio. And procedures for determining optimal conditions based on the new metric is presented. The effectiveness of the proposed approach over the traditional practice is tested with the aid of a wave soldering process.

의사결정이론을 이용한 박판성형공정의 최적화

김경모(Kyung-Mo Kim),인정제(Jeong-Je Yin) 한국기계가공학회 2012 한국기계가공학회지 Vol.11 No.2

Wrinkle and fracture are two major defects frequently found in the sheet metal forming process. In this process there are more than one design attributes to optimize and several uncontrollable factors which cannot be ignored in determining the optimal values of design variables. Therefore, attempts to reduce defects through a traditional optimization technique are often led to failures. In this research, a new design method for reducing the wrinkle and fracture under uncontrollable factors is presented by using decision-making theory. To avoid the psychological difficulties in determining the scaling constants of the multi-attribute utility function by using the ordinary lottery questions, a pair-wise comparison procedure is adapted to avoid this problem. The effectiveness of the proposed method is illustrated through a robust design of sheet metal forming process of a side member of an automotive body.

중국 고급중학교 <사상정치 1: 경제생활>교과 분석 연구

김경모 ( Kyung Mo Kim ) 한국경제교육학회 2016 경제교육연구 Vol.23 No.3

본 연구는 우리나라 고등학교의 〈경제〉 과목에 해당하는 중국의 고급중학교의 <사상정치1: 경제생활> 교과를 대상으로 단원별 내용 체계와 구성 체계를 분석 하였다. 내용 분석의 결과 <사상정치1: 경제생활>은 이전 교육과정표준 시기에 비해 마르크스 경제학의 계통성 보다는 현실 경제문제와 경제생활을 강조하고 있다는 점, 내용의 구성에서 소비자, 생산자, 정부 등의 사회적 역할을 강조하는 등의 특징을 보이고 있다. 구성체계에서는 문제중심의 내용을 단순한 내용 전달보다는 학생들의 학습 동기화와 활동, 이를 지원하기 위한 다양한 자료와 심화 활동 등을 강조하는 특징을 보이고 있다. 전체적으로 <사상정치1: 경제생활〉교과는 이전 교육과정표준 시기에 비해 교육과정 면에서는 경제생활과 문제를 강조하고 있으며 교과서의 내용 구성 방법과 관련하여서는 본문 위주의 일방 적인 전달을 위한 교과서 체제에서 벗어나 내용과 구성체제의 측면에서 학생의 주도적 활동을 적극적으로 끌어내기 위한 보조문의 역할이 강조되고 있는 것으로 평가된다. The purpose of this study is to analyze the content and structural system of curriculum and textbook of < Ideology and Politics 1: Economic Life >. Main characteristics of content system of curriculum and textbook are as follows. First one is that the authentic economic problems of China are emphasized comparing the previous national curriculum standard which is focused on the Marxian economic concepts and principle itselves. Second one is that the contents are organized around the social role of economic life. This characteristics is interrelated with the first one of the economic problem based contents. As far the structural system of textbook being more emphasis are put on the various data and in-depth activity for motivating the readiness of student and supporting the class learning. For teis the related examples of economic life and history and questions are given in advance at the head of main text in the level of individual lesson theme. In addition < analysts of expert > and < concept explanation > are designed to explain additionally and make and in depth explanation of concepts. The < related data > is making main text more rich through providing the photo and statistical data. The < comprehensive inquiry activity > located in every unit is main tool for strengthening the student activities focusing on the most important in-depth lesson theme.

출생 첫날 출현한 황달과 용혈성 빈혈로 내원한 Glucose-6-Phosphate Dehydrogenase 결핍증

김경모 ( Kyung Mo Kim ),이정현 ( Jung Hyun Lee ),전정식 ( Chung Sik Chun ) 대한주산의학회 2006 Perinatology Vol.17 No.1

The most devastating clinical consequence of G-6-PD deficiency is neonatal hyperbilirubinemia which can be severe and result in kernicterus or even death, although glucose-6-phosphate dehydrogenase deficiency is responsible for two clinical syndromes, an episodic hemolytic anemia induced by infections or certain drugs and spontaneous chronic nonspherocytic hemolytic anemia. In the pathogenesis of neonatal hyperbilirubinemia associated with G-6-PD deficiency, decreased elimination of bilirubin has been suspected to be a key factor, because these neonates usually do not develop frank anemia even in the presence of severe hyperbilirubinemia. But, we experienced a glucose-6-phosphate dehydrogenase deficient male patient who showed jaundice and severe hemolytic anemia appearing within the first 24 hour of life. The patient had resolution of symptoms after phototherapy and transfusion. We report this case with a brief review of the related literatures.