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.

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.

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

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.

에너지 수확 무선 센서 네트워크에서 에너지 효율 및 우선순위 기반의 MAC 프로토콜

김성철,전준헌,Kim, Seong-Cheol,Jeon, Jun-Heon 한국정보통신학회 2013 한국정보통신학회논문지 Vol.17 No.3

무선 센서 네트워크에서 다중접근제어(Medium Access Control: MAC) 프로토콜은 센서 노드들이 필요할 때만 on 상태에 머물게 함으로 에너지를 효율적으로 사용하도록 하게한다. 본 논문에서는 에너지 수확 무선 센서 네트워크에서 우선순위에 기반을 둔 에너지 효율적인 MAC 프로토콜(EEPB-MAC)을 제안한다. 제안된 EEPB-MAC은 기존의 IEEE 802.15.4의 비콘 프레임에 우선순위 비트, 전송 노드 주소, NAV 값을 가지는 필드를 추가하여 이를 통하여 우선순위 데이터 전송을 지원한다. 데이터 전송을 원하는 전송자로부터 비콘 프레임을 수신한 수신 노드는 수신된 비콘 프레임의 우선순위 비트에 기반으로 데이터를 전송할 전송자를 선택한다. 데이터의 특성에 따라 우선순위 전송을 지원할 뿐 만 아니라, 수신 노드의 잔여 에너지 레벨에 따라 전송 주기를 조절하는 등 데이터 전송에 참여하는 노드에서의 에너지 소모를 줄인다. EEPB-MAC 프로토콜은 기존에 제안된 다른 프로토콜에 비해 우선순위가 높은 데이터에 대한 전송지연을 줄이며, 각 노드에서의 에너지 소모를 개선시켰다. Medium access control (MAC) protocols for wireless sensor networks make sensor nodes on state for energy-efficiency only when necessary. In this paper we present an energy efficient priority-based MAC protocol for energy-harvesting Wireless Sensor Networks (WSNs). For support priority-based packet transmission the proposed EEPB-MAC protocol uses the modified IEEE 802.15.4 beacon frames including priority bit, sender node address, and NAV value fields. A receiver node periodically wakes up, receives sender beacon frames, selects data sending sender, and broadcasts a beacon frame containing the selected sender's address. A receiver node selects sender node according to sender's data priority. A receiver nodes also adjust wake up period based on their energy states. Hence, the energy consumption of receiver node can be minimized. Through simulations and analytical analysis, we evaluate the performance of our proposed the EEPB-MAC protocol and compare it against the previous MACs. Results have shown that our protocol outperforms other MAC in terms of energy consumption, higher priority packet delivery delay.

생혈액분석을 통한 저용량 He-Ne 레이저 유침치료에 관한 임상적 연구

김성철,Kim, sung-chul 대한침구의학회 2001 대한침구의학회지 Vol.18 No.3

Objective : The purpose of this study was to investigate the effect of Intravascular Laser Irradiation of Blood(ILIB) by the live blood analysis. Methods : We had analysed the changing forms of the live blood samples with Ultra Darkfield Microscope before and after Intravascular Laser Irradiation of Blood. Results and Conclusion : 1. Nomal Erythrocytes were increased significantly after ILIB by the live blood analysis. 2. Poikilocytes were decreased significantly after ILIB by the live blood analysis. 3. Target Cells were decreased significantly after ILIB by the live blood analysis. 4. Somatid was improved significantly after ILIB by the live blood analysis. 5. Erythrocyte Aggregtion was improved significantly after ILIB by the live blood analysis.

WPAN시스템에 미치는 WLAN 시스템의 간섭신호 경감을 위한 MAC schedule 기법에 관한 연구

김성철,Kim, Seong-cheol 한국정보통신학회 2015 한국정보통신학회논문지 Vol.19 No.10

본 논문은 멀티미디어 환경하에서 WPAN 시스템에 미치는 WLAN 시스템의 간섭신호 경감을 위한 MAC schedule 기법에 대해 연구한다. 본 연구에서 고려하는 파라미터는 간섭신호평가와 주장치 지연정책을 고려한다. 제안된 스케쥴링 기법은 패킷 전송손실과 다중 슬롯 패킷의 경우 전송지연시간을 감소시키는데 효과적임을 알 수 있었다. 또 다른 장점은 채널 상태가 나쁠 경우 패킷의 전송이 이루어지지 않기 때문에 전송 전력의 낭비를 막을 수 있다는 것이다. 더욱이 다른 장치에 의해 차지하고 있는 채널을 피함으로 인해 같은 주파수 대역을 사용하고 있는 다른 시스템으로의 간섭의 영향을 줄일 수 있었다. 음성 패킷은 고정된 기간에 보내지기 때문에 스케쥴링 정책은 데이터 트래픽에 한하여 적용된다. 그러나 지연분산이 일정하고 한 슬롯내로 제한된다면 음성을 위한 DM패킷에도 적용 가능 할 것이다. This paper describes packet scheduling techniques that can be used to alleviate the impact of interference. The mechanism is consisted of interference estimation and master delay police. Proposed scheduling police is effective in reducing packet loss and delay. Another advantage worth mentioning, are the additional saving s in the transmitter power since packet are not transmitted when channel is bad. This paper gives that scheduling policy works only with data traffic since voice packets need to be sent at fixed intervals. However, if the delay variance is constant and the delay can be limited to a slot, it may be worthwhile to use DM packet for voice.

새로운 교육 패러다임을 기대해 본다

김성철,Kim, Seong-Cheol 한국대학교육협의회 2000 大學敎育 Vol.104 No.-