선천성 장폐쇄증 2차 조사 - 대한소아외과학회 회원을 주 대상으로 한 전국조사 -

김성철,김대연,김상윤,김인구,김인수,김재억,김재천,김현영,박귀원,박우현,박진영,서정민,설지영,오수명,오정탁,이남혁,이명덕,이석구,이성철,정상영,정성은,정연준,정풍만,최금자,Kim, Seong-Chul,Kim, D.Y.,Kim, S.Y.,Kim, I.K.,Kim, I.S.,Kim, J.E.,Kim, J.C.,Kim, H.Y.,Park, K.W.,Park, W 대한소아외과학회 2010 소아외과 Vol.16 No.1

본 조사는 2007년부터 2009년까지 3년간 본 학회 정회원들에 의하여 수술받은 장폐쇄증 환아를 대상으로 한 후향적 조사이다. 또한 본 학회에서는 1994년부터 1996년까지 3년간의 증례를 대상으로 같은 조사(1 차조사)를 진행한 바 있다. 1 차 조사와 비교하여 본 조사에서 보이는 특징은 아래와 같이 요약할 수 있다. - 총 증례 수는 비슷하였으나 출생률을 감안하여야 할 것이다. - 각 기형별 비율은 비슷하였다. - 미숙아 및 저출생체중아의 비율은 증가 하였다. - 산전진단율은 증가하였다. - 복부단순촬영만 한 경우는 감소하였다. - 다른 기형이 동반된 예가 증가하였다. - 사망률이 13.8 %에서 3.6 %로 감소하였다. 장운동의 회복은 공장폐쇄증에서 십이지장이나 회장폐쇄증에서 보다 더뎠다. 하지만 십이지장-공장 이행부에서 문합부까지의 거리가 기술되지 않은 예가 많아 소위 "High Jejunal obstruction"에서의 장운동 회복기간을 알아 보지 못 하는 아쉬움이 있었다. 또한 주름형성술(plication) 또는 장의 직경을 줄이는 수술(tapering)의 효과도 시행한 예수가 작고, 문합부 위치의 기술 부족으로 알아 보지 못 하였다. 십이지장폐쇄증의 화타씨유두부와 위치 역시 향후 보다 정확한 수술기록을 토대로 조사되어야 할 것으로 생각된다. 치료 성적의 눈부신 향상은 여러 회원들의 각고의 노력과 의학의 발달에 기인한 것으로, 사망률 0 %를 향한 노력이 지속되어야 할 것이다. The members of the Korean Association of Pediatric Surgeons conducted a retrospective study of two hundred and twenty-two cases of intestinal atresia for the period from January 1, 2007 to December 31, 2009. Seventeen hospitals were involved. There were 76 duodenal, 65 jejunal, and 81 ileal atresias (3 colonic). The male to female ratio was 0.85:1 in DA and 1.34:1 in JIA. Ninety-four patients(43.3 %) were premature babies (DA 40.3 %, JA 64.6 %, IA 28.8 %), and 70 babies (32.0 %) had low birth weight (DA 38.7 %, JA 44.4 %, IA 16.0 %). Antenatal diagnosis was made in 153 cases (68.9 %). However, 27 infants (17.6 %) with antenatal diagnosis were transferred to the pediatric surgeon's hospitals after delivery. Maternal polyhydramnios was observed in 81 cases (36.59 %) and most frequent with proximal obstruction. In forty-four cases (19.8 %), only simple abdominal film was taken for diagnostic study. The associated malformations were more frequently observed in DA - 61.8 % in DA and 22.6 % in JIA. Meconium peritonitis, small bowel volvulus and intussusception were more frequently associated with ileal atresia. The overall mortality rate was 3.6 %. (Abbreviations: DA;duodenal atersia, JA;jejunal atresia, JIA;jejunoileal atresia, IA;ileal atrsia).

선천성 식도무공증의 임상적 고찰

김성철,김대연,김애란,김기수,피수영,김인구,Kim, Seong-Chul,Kim, Dae-Yeon,Kim, Ellen Ai-Rhan,Kim, Ki-Soo,Pi, Soo-Young,Kim, In-Koo 대한소아외과학회 2003 소아외과 Vol.9 No.1

This study reviews 14 years' experience treating esophageal atresia with special emphasis on the clinical profile and outcome. From May 1989 to February 2003, 65 cases of esophageal atresia (EA) were treated at Asan Medical Center. Boys outnumbered girls 2.4 to 1. Prematutity and low birth weight were 27.7% and 38.5%. Esophageal atresia with distal tracheoesophageal fistula (TEF) was the most common type (87.7%), followed by pure EA and H type fistula. Forty-six patients (70.8%) had one or more associated anomalies, cardiac malformations were the most common. Duodenal atresia was found in 7 cases. There were 6 patients (9.2 %) with VATER cluster. VACTERL cluster was present in 18 patients (27.7%), one of who fulfilled the complete syndrome. Waterston group A, B and C made up 21.5%, 40.0% and 38.5% of the total group. Surgical treatment was attempted in 63 patients and deferred in 2 who had severe associated malformations. For EA with distal TEF, primary esophago esophagostomy was carried out in 51 cases, and division of TEF and gastrostomy in 4 cases and no operation in 2 cases. For pure EA, colonic graft was done in 2 after gastrostomy and esophagostomy, and esophago esophagostomy was performed in 2 after gastrostomy. Two patients with pure EA are waiting for the second operation after gastrostomy. Division of TEF was carried out in 2 cases with H type TEF. The overall survival rate was 76.9%, and survival by Waterston classification was 100% in group A, 80.8% in B and 60.0% in C. Thorough workup for associated anomalies, interdepartmental approach and more careful surgical decision and technique are required to improve the outcome of EA.

소아 및 청년층의 치루와 항문주위농양

김성철,김진천,김인구,Kim, Soong-Chul,Kim, Jin-Cheon,Kim, In-Koo 대한소아외과학회 1995 소아외과 Vol.1 No.1

Anal fistula and perianal abscess in pediatric patients have been reported to have several characteristics, e.g. prevalent in less than 2 years of age, male preponderance, straight course of tract, and low type of fistula. We performed a retrospective study of twenty nine pediatric patients to see these characteristics comparing with the transitional age group of adolescents. Between June 1989 and December 1993, twenty-nine pediatric (<15year-old) and sixteen adolescent patients(${\geqq}$15, <25 year-old) with anal fistula and perianal abscess were treated by surgical intervention. Perianal abscess and anal fistula in the pediatric group had the predilection for male(100%), age less than two years (72.4%), low type(100%), and lateral localization(87.5%). But the features of the adolescent group were similar to those of adult. Twenty-one(87.5%) and 10(66.7%) enteric bacterial colonies were isolated from 16 pediatric and 11 adolescent patients, respectively. Considering the predominance of low type and the organisms cultured in the pediatric group, crypt-glandular infection seems to be a major preceding event. Incision and drainage were sufficient for cure in 15 among 16 perianal abscesses, and fistulas were cured by either fistulotomy or fistulotomy in all the 14 patients. The importance of effective drainage of perianal abscess and fistulotomy including internal opening cannot be overemphasized.

소아 위식도 역류 질환의 외과적 치료

김성철,김대연,김경모,김인구,Kim, Seong-Chul,Kim, Dae-Yeon,Kim, Kyung-Mo,Kim, In-Koo 대한소아외과학회 2000 소아외과 Vol.6 No.2

Eleven children with gastroesophageal reflux disease underwent fundoplication. Eight had neurological impairment, two had hiatal hernias and one had a history of esophageal repair for esophageal atresia. The most common and significant symptom was vomiting(81.8 %), followed by recurrent respiratory infections(72.7 %) and failure to thrive(72.7 %). The most common diagnostic tool was 24 hour esophageal pH study, which showed pH less than 4 for more than 10 % of the total recorded time in 6 of 9 patients. Nissen fundoplication was performed in 10 patients. Thal fundoplication was carried out in one patient with esophageal atresia. Stamm gastrostomy was added for nutritional and/or swallowing problem in all 8 patients with neurological impairment. The median follow up period was 13 months. There was one late death of unrelated cause and one recurrence. The quality of life after antireflux surgery was greatly improved. Antireflux surgery should be done if indicated, and a simultaneous gastrostomy considered in a patient with neurological impairment.

물관리시설에 AI적용을 위한 플랫폼 알고리즘의 중요성

김성철,류범수,장근수,김광식,정준연,구자옥,이권재,한동일,김창용,심규대,송성옥,박득호,우일,장인재,김석기,김성호,최범순,나병국,홍석환,Kim, Seong-Cheol,Ryu, Beom-Su,Jang, Geun-Su,Kim, Gwang-Sik,Jeong, Jun-Yeon,Gu, Ja-Ok,Lee, Gwon-Jae,Han, Dong-Il,Kim, Chang-Yo 한국수자원학회 2022 물과 미래(한국수자원학회지) Vol.55 No.8

일란성 쌍둥이 모두에서 발생한 식도무공증

김성철,남소현,김대연,김인구,Kim, Seong-Chul,Nam, So-Hyun,Kim, Dae-Yeon,Kim, In-Koo 대한소아외과학회 2009 소아외과 Vol.15 No.2

Although the incidence of esophageal atresia (EA) is higher in twins than in singletons by two to three times, EA usually affects only one member of twins. We report one pair of twins concordant for EA. A 31-year-old healthy woman bore monozygotic female twins at 36 weeks of gestation. They weighed 2,216 and 2,480 g, respectively. They had EA with distal tracheoesophageal fistula and underwent primary esophageal anastomosis on the birth day and the $2^{nd}$ day of life, respectively. Twin A also had suspicious antral obstruction and pyloroplasty was done simultaneously with esophageal repair. She needed antral web excision for continued gastric stasis one month after $1^{st}$ operation and three balloon dilatations of the esophagus. Twin B recovered uneventfully.

양하의 근경에서 항균성 물질 분리 및 구조동정

김성철,송은영,김공호,권혁모,강상헌,박기훈,정용환,장기창,Kim, Seong-Cheol,Song, Eun-Young,Kim, Kong-Ho,Kwon, Hyeog-Mo,Kang, Sang-Heon,Park, Ki-Hun,Jung, Yong-Hwan,Jang, Ki-Chang 한국응용생명화학회 2003 한국농화학회지 Vol.46 No.3

양하(Zingiber mioga Roscoe) 근경의 에탄을 추출물을 재료로 Staphylococcus aureus, Bacillus subtilis 및 B. cereus에 대한 activity-guided fractionation을 실시하여 항균성 물질 세가지준 얻었다. 항균력실험 결과, 화합물 I과 111은 세가지균주 모두에 활성이 있었고, 화합물 II에서는 B. subtilis과 B. cereus에서만 활성이 나타났다. 그 중에서 가장 활성이 강한 화합물 I을 Bioscreen C로 optical density(600 nm)를 측정하여 증식억제실험을 한 결과 10 ppm 처리시 B. subtilis과 B. cereus에서 72시간동안 강한 증식억제효과를 나타내었으며, S. aureus에서는 25 ppm 처리시 72시간동안 완전증식억제효과를 나타내었다. $1^H-NMR$, ${13}^C-NMR$, DEPT,$1^H-1^H$ COSY, HMQC, HMBC 및 IR 스펙트럼 등을 분석한 결과 화합물 I, II, III은 labdane-type diterpene인 $(E)-8{\beta}(17)-epoxylabd-12-ene-15,16-dial(C_{20}H_{30}O_3,\;MW=318)$, $galanolactone(C_{20}H_{30}O_3,\;MW=318)$ 그리고 galanal A($C_{20}H_{30}O_3,\;MW=318$)로 각각 동정되었으며, 이들은 양하의 근경에서는 처음 분리된 것이다. In order to isolate antibacterial substances from the rhizome of Zingiber mioga Roscoe, the ethanol extracts was fractionated according to the activity against Bacillus subtilis, B. cereus and Staphylococcus aureus. Three antibacterial substances were isolated and purified by column chromatography and recrystallization. Compounds I and III showed activity against all the tested bacterias and compound II exhibited the activity against B. subtilis and B. cereus S. aureus. Compound I was examined antimicrobial activity against B. subtilis, B. cereus and S. aureus by optical density using Bioscreen C. Compound I showed strong growth inhibition at 10 ppm on B. subtilis and B. cereus for 72 hrs, and at 25 ppm on S. aureus. On the basis of spectrometric studies including $1^H-NMR$, ${13}^C-NMR$, DEPT, IH-lH COSY, HMQC, HMBC and IR, compounds I, II and III were identified as $(E)-8{\beta}(17)-epoxylabd-12-ene-15,16-dial\;(C_{20}H_{30}O_3,\;MW=318)$, galanolactone $(C_{20}H_{30}O_3\;MW=318)$ and galanal A $(C_{20}H_{30}O_3,\;MW=318)$, respectively. These results are the first reports on the isolation of $(E)-8{\beta}(17)-epoxylabd-12-ene-15,16-dial, galanolactone and galanal A from the rhizome of Zingiber mioga.

성매매 피해 여성의 외상 후 스트레스 증상과 정신건강-탈 성매매 후 추적 연구

김성철,이준우,송정민,전태연,채정호,Kim, Seong-Cheol,Lee, Jun-Woo,Song, Jeong-Min,Jun, Tae-Youn,Chae, Jeong-Ho 대한불안의학회 2006 대한불안의학회지 Vol.2 No.1

Objectives : Since prostitution is multitraumatic phenomena, it is known that most women in prostitution have symptoms of posttraumatic stress disorder (PTSD) and other mental illness. In Korea, new anti-prostitution law launched in the year of 2004 imposes protecting prostituted victims at government-supported shelter. The objective of this study was to compare the mental symptoms, especially PTSD features of women who escaped from prostitution with those of control subjects. Methods : We assessed 113 ex-prostituted women who live in shelter for 8 months on the average and 65 normal control subjects. Demographic data, questionnaire for sleep, physical illness, smoking, alcohol and drug use, Stress Response Inventory, Davidson Trauma Scale (DTS), Impact of Event Scale-Revised (IES-R) were used. Results : Ex-prostituted women had significantly higher scores of DTS, IES-R, stress related responses, sleep problems, smoking problems, and alcohol problems than control group. Age and duration of sex trade of the subjects were significantly correlated with the severity or frequency of PTSD symptoms. The degree of smoking, alcohol drinking and sleep problems were also significantly correlated with the PTSD symptoms. Conclusion : These results suggested mental symptoms did not disappear even after women escaped from prostitution.

IEEE 802.11e 무선 LAN에서 공평성 있는 전송을 지원하는 Enhanced EDCF 알고리즘

김성철,Kim Seong-Cheol 한국정보통신학회 2004 한국정보통신학회논문지 Vol.8 No.8

경쟁기반의 무선 랜에서 채널의 이용률을 최대로 하는 것과 대역폭의 공평한 할당은 다루어야 할 중요한 주제이다. 그러나 위의 두 목적을 동시에 달성하는 것은 매우 어렵다. 이들 목적을 위하여 많은 연구들이 이루어져왔다. 본 논문에서는 IEEE 802.11e 무선 랜에서 여러 트래픽 클래스 간의 공평한 전송을 지원할 수 있는 제어 메커니즘을 제안한다. 제안된 알고리즘에서 각 클래스 트래픽들이 자신의 평균 long-term과 short-term 전송시간 값의 차이와 자신에게 할당된 전송 시간을 비교하여 $CW_{min}$값을 조절함으로써 공평성을 지원한다. 제안된 알고리즘은 공평성 지원을 위하여 다른 연구에서와 같이 각 트래픽 클래스들이 네트워크 내의 정확한 노드의 수에 대한 예측을 필요로 하지 않는다. 뿐만 아니라 AP(Access Point)나 모바일 호스트에 어떠한 수정도 필요하지 않는 장점을 가진다. In a contention-based wireless LAN protocol, maximization of channel utilization and fair bandwidth allocations are main topics to deal with. But it is very difficult to achieve these two goals simultaneously. Many studies have been done to achieve these goals. In this paper we propose a control mechanism to support fair transmissions among traffic classes in IEEE 802.11e Wireless LAN. The proposed algorithm uses short-term and long-term transmission times of each traffic classes to control their $CW_{min}$ for fairness. The proposed algorithm don't need to know the exact number of nodes in the networks to support fairness as other studies do. Furthermore any modifications in AP and mobile hosts are not required.

FIDIC에 의한 건설계약 분쟁 해결방안에 관한 연구

김성철,정병화,Kim, Seong-Chirl,Jung, Byeong-Hwa 한국건축시공학회 2010 한국건축시공학회지 Vol.10 No.4

해외건설공사에서는 종종 예기치 않는 환경에서 공사를 시공하는 상황에 직면하게 되는 경우가 있다. FIDIC에 있어서 예기치 않는 상황이 발생할 시 건설계약의 변경을 행하기 위해 시공자는 감독자에게 클레임을 통보하는 권리를 가지며, 발주자와 시공자 간의 화해가 성립하지 않을 경우에는 분쟁이 발생한다. 시공자가 발주자 보다 상황변화에 관한 더 상세한 자료를 가지고 있고 정보의 비대칭성을 초래하여 감독자나 중재자의 판단오류와 교섭에 의한 화해이득을 기대한 분쟁이 발생할 가능성이 있다. 본 연구에서는 분쟁 발생원인과 시공자의 클레임 이동에 착안하여 제3자에 의한 분쟁조정의 방식과 비용부담률이 분쟁발생에 관한 기법을 게임이론을 이용하여 분석하였으며 또한 그 모델을 클레임에 관한 DAB/DGB의 영향도 분석하였다. 그 결과 제3자의 조정에 있어서 과오의 확률을 작게 하는 것이 분쟁을 효율적 해결할 수 있다고 판단된다. 이에 급속한 건설시장의 변화에 대처하기 위해 해외건설공사의 계약관리 강화방안을 제시하고자 한다. International construction contractors are often faced with the situation of working in an unfamiliar construction environment. Under FIDIC rules, the contractor has the right to make a claim requesting the consulting engineer for an adjustment to the contract price or the time for completion when a part or parts of the works have changed, or in the event of unforeseeable conditions. Contractors generally have more access to the costs and time implications of such a change or unforeseeable conditions than the consulting engineer or outside neutrals. Due to such an asymmetry of information, the contractor may be motivated to dispute frivolous claims of less merit, expecting erroneous judgments by the consulting engineer or the neutrals. In this paper, a claiming behavior model is presented by using game theory and experience data to study the manner in which frivolous claims develop into disputes. The model also analyzes the impacts of DAB/DRB upon the frivolous claims.