근위부 위절제술 후 재건 술식에 따른 경과 관찰

김지훈,육정환,김병식,오성태,Kim, Ji-Hoon,Yook, Jeong-Hwan,Kim, Byung-Sik,Oh, Sung-Tae 대한위암학회 2006 대한위암학회지 Vol.6 No.1

목적: 근위부 위절제술 후 식도-위 문합술을 시행받은 환자에서 문합부 협착, 역류성 식도염 등이 드물지 않게 발생한다. 저자들 역시 이러한 합병증을 경험하였고 이를 극복하기 위한 방법으로 공장간치술을 시행하였으며 식도-위 문합술과 공장간치술 간의 경과 관찰을 통해 보다 나은 재건 술식을 찾고자 하였다. 대상 및 방법: 1998년 6월부터 2002년 12월까지 울산의대 서울아산병원 외과에서 상부위암 혹은 위상부의 위장관기질종양으로 진단받고 근위부 위절제술을 시행한 환자를 대상으로 재건 술식에 따른 수술시간, 수술 후 증상, 체중변화, 추적관찰 시 시행한 내시경 소견 등을 비교하였다. 결과: 대상 환자 총 33명의 평균연령은 59세였고, 남녀 비는 3 : 1이었다. 식도-위 문합술을 시행한 환자는 25명, 공장간치술을 시행한 환자는 8명이었다. 통과장애, 속쓰림, 신트림, 구토 등의 증상을 관찰하였으며 식도-위 문합술 환자에서 통과장애 12예, 구토 3예, 속쓰림 4예, 신트림 4예가 관찰되었으며, 공장간치술 환자에서는 통과장애 12예, 구토 3예가 있었고, 속쓰림과 신트림은 관찰되지 않았다. 수술 후 체중변화는 1개월 후 수술 전 체중의 90%까지 감소한 경우가 식도-위 문합술 환자에서 7예, 공장간치술 환자에서 없었다. 수술 후 추적 내시경 검사 결과 역류성 식도염이 관찰된 경우는 식도-위 문합술 환자에서 9예, 공장간치술 환자에서 0예였다. 문합부위 협착으로 인해 풍선 확장술이 필요하였던 경우가 식도-위 문합술 환자에서 4예, 공장간치술 환자에서 1예가 있었다. 결론: 상부 위절제 시 재건방법으로 역류성 식도염 및 여러 소화기 증상을 예방하기 위해 공장간치술이 식도-위문합술의 대안이 될 수 있다고 생각한다. 하지만 통계적 유의성을 가지기 위해 더 많은 대상군이 포함되어야 할 것이다. Purpose: A proximal gastrectomy is performed for gastric cancer in the upper part of the stomach to preserve the function of the stomach after surgery. An esophagogastrostomy is one of the common reconstruction methods for a proximal gastrectomy, but this method results in a high incidence of reflux esophagitis. This study was undertaken to compare subjective and functional results between esophagogastrostomy and jejunal interposition reconstructions. Materials and Methods: From June 1998 to December 2002, proximal gastrectomies were performed in 33 patients with tumors in the upper third of the stomach; 8 had reconstruction using jejunal interposition between the esophagus and the remnant stomach (JI group) while 25 had reconstruction using esophagogastrostomy (EG group). The postroperative courses of the patients were reviewed in terms of symptoms, weight changes, and endoscopic findings. Results: The mean age of the patients was 59 years; 26 were men and 7 were women. There were no significant differences in general complications, operating times, or histologic features between the two groups. Fifty-two percent (52%) of the EG group complained of dysphagia, and 16% them experienced heartburn and acid belching. Twelve percent (12%) of the JI group complained of dysphagia, but heartburn and acid belching did not occur. Incidences of reflux esphagitis (36%) and balloon dilatation for anastomotic stricture (16%) were more common in the EG group than in the JI group (0% and 12%). Conclusion: To prevent or minimize complications, such as reflux esophagitis and postoperative symptoms, a proximal gastrectomy with a jejunal interposition is an alternative method as an organ-preserving surgical strategy to improve quality of life for patients. (J Korean Gastric Cancer Assoc 2006;6:1-5)

하라다병 환자에서 섬모체맥락막 삼출로 인해 발생한 양안의 급성 근시와 전방각 폐쇄 1예

김지훈,임재석,이지웅,이지은,엄부섭,Ji Hun Kim,MD,Jae Seok Lim,MD,Ji Woong Lee,MD,Ji Eun Lee,MD,PhD,Boo Sup Oum,MD,PhD 대한안과학회 2012 대한안과학회지 Vol.53 No.8

Purpose: To report a case of bilateral acute myopia and angle-closure with ciliochoroidal detachment in Vogt-Koyanagi-Harada (VKH) syndrome. Case summary: A 43-year-old Korean woman diagnosed with VKH syndrome underwent intravenous methylprednisolone steroid pulse treatment. After oral medication was given for 2 days, the anterior chambers became shallow in both eyes. Intraocular pressure (IOP) increased to 25 mm Hg in the right eye and 23 mm Hg in the left eye. Subretinal fluid increased and visual acuity decreased with myopic shift in both eyes. IOP did not decrease despite maximum tolerated medical therapy. Ultrasound biomicroscopy (UBM) revealed that ciliochoroidal effusion caused forward displacement of the lens-iris diaphragm, which resulted in anterior chamber shallowing and angle closure in both eyes. The patient was treated with cycloplegic eyedrops and intravenous steroid pulse therapy. After intravenous steroid pulse treatment was given for 2 days, the anterior chambers became deep in both eyes. IOP reduced to 13 mm Hg and 14 mm Hg in the right and left eye respectively. Visual acuity increased with normalization of myopic shift. UBM revealed that the ciliochoroidal effusion had resolved in both eyes. J Korean Ophthalmol Soc 2012;53(8):1194-1199

자돈에 있어 산미제의 질병예방 및 면역증강 기능

김지훈,Kim, Ji-Hun 한국단미사료협회 2004 사료산업 Vol.2 No.11

족관절의 골절-탈구에 대한 임상적 고찰

김지훈,송재광,서진수,Kim, Ji Hoon,Song, Jae Gwang,Suh, Jin Soo 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.3

Purpose: We evaluate clinical manifestations and radiologic features of ankle fracture & dislocation, as well as the usefulness of computed tomography on posterior ankle fracture & dislocation to study factors contributing to ankle fracture & dislocation. Material and Methods: Ankle dislocation was defined as the center of talar body being translated over the cortex of tibia on AP or lateral view on simple X-ray. Surgical treatments of 30 patients from January 2007 to March 2012 were categorized according to the injury mechanism, the direction of dislocation and fracture site. Joint involvement of posterior malleoalr fracture was evaluated through simple x-ray and computed tomography. We treated surgically if posterior malleolus fracture involves more than 25% of dital tibial articular surface. Thereafter, clinical outcomes were identified through radiographs and by using the AOFAS score. Results: The mean age was 42(13-78) years old, and slip down was the most common injury mechanism (13 cases). Car accident (6 cases) and fall accident (4 cases) were the next frequently found injury mechanisms. As for the types of ankle fracture, posterior fracture and dislocation (21 cases, 43.3%) was most commonly found. Out of these 21 cases, 15 cases involved trimalleolar fracture, and 19 cases were associated with posterior malleolar fracture. Danis-weber type B and C patients were 11 cases and 10 cases respectively. Articular involvement of posterior malleolar fracture turned out to be average 27.9%(5.1%~49.1%) on simple x-ray. The rate was evaluated as average 31.7%(12.6%~55.3%) on computed tomography which was conducted 15 times, and led us to more meaningful data. Conclusion: Anterolateral fracture and dislocation often accompanied open dislocation. Posterior fracture dislocation was most commonly found. Posterior malleolus was an important factor that ensures posterior stability of the ankle joint. Computed tomograph is useful to evaluate the articular involvement of posterior malleolar fracture.

돼지의 사료섭취량에 영향을 주는 요인들(1)

김지훈,Kim, Ji-Hun 대한양돈협회 1999 養豚 Vol.21 No.10

대형등명기 모니터링 시스템 설계 및 구현

김지훈,예성현,한순희,Kim, Ji-Hoon,Ye, Seong-Hyeon,Han, Soonhee 한국정보통신학회 2014 한국정보통신학회논문지 Vol.18 No.10

우리나라는 해안선이 복잡하여 연안을 항해하는 선박이나 어선의 안전한 항해 및 조업을 위해 효과적인 항로표지 운영이 필요하다. 특히 대형등명기는 야간에 항상 점등되어 선박의 안전을 보장해야 한다. 등대에 설치된 대형등명기가 점등되지 않을 경우 자신의 선위를 확인할 수 없어 사고가 발생하기 쉬우며 이는 커다란 경제적 피해를 야기할 수 있다. 본 연구에서는 대형등명기의 상태정보를 감시 제어하는 대형등명기 모니터링 시스템을 설계하고 구현하였다. 이 시스템은 다양한 장애상황에 신속히 대처하여 해양 안전사고를 미연에 방지할 수 있도록 하는데 그 목적이 있다. Our country has a convoluted coastline and the marine weather fluctuates locally, so it needs effective AtoN operation for the safe navigation of vessels and fishing boats sailing the coast. Especially, large beacon must ensure the safety of the vessels and always lit at night. If large beacons installed in the lighthouse are not lit, vessels can not assure their location. Thus the accidents is likely to occur, which can cause great economic damage. In this paper, we developed a monitoring system of large beacon to monitor and control the status of information. This system was designed for a special purpose of taking precautions against possible accidents on the sea.

소족지 변형에서 시행한 관절 절제 성형술

김지훈,박형준,서진수,Kim, Ji Hoon,Park, Hyung Jun,Suh, Jin Soo 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.4

Purpose: The objective of this study was to examine the clinical results and effectiveness of resection arthroplasty for correction of lesser toe deformity. Materials and Methods: From January 2000 to November 2012, 92 cases of resection arthroplasty for lesser toe deformity were reviewed. Hammer toe was the most common type of deformity, accounting for 44 toes (33 patients). Hallux valgus was the most common comorbid illness. Second toe was the most commonly affected toe and proximal interphalangeal joint was the most common location of resection arthroplasty (69 toes, 75.0%). We also analyzed the alignment of phalanges using the last follow-up weight bearing radiographic image. The analysis included clinical evaluation with American Orthopaedic Foot and Ankle Society (AOFAS) score as well as subjective satisfaction. Results: Flexor tenotomy (19 cases) was the most common combined surgery. Floating toe (4 cases) was the most common complication. The last follow-up alignment of phalanges was better than good in 71 toes (77.2%) in anteroposterior view and in 69 toes (75.0%) in lateral view. Sixty one cases (85.9%) resulted in better satisfaction than 'good' and the final average AOFAS score was 87.4. Conclusion: Resection arthroplasty is a valuable surgical option for treatment of lesser toe deformity, with high patient satisfaction, easy surgical technique and remarkable correction of deformity.

The Interplay between Star Formation and AGN Activities : A Case Study of LQSONG

김지훈,임명신,김도형,Kim, Ji Hoon,Im, Myungshin,Kim, Dohyeong 한국천문학회 2012 天文學會報 Vol.37 No.2

One of the most intriguing questions regarding black hole (BH)-galaxy co-evolution picture is how the BH accretion, or active galactic nucleus (AGN) activity is linked to star formation (SF) activity. While it is suggested that AGN luminosity of quasars correlates with SF luminosity, it is still unclear how AGN activity is connected to SF activity based on host galaxy properties. Utilizing AKARI's unique slit-less spectroscopic capability and wavelength coverage, we probed star formation activity of several types of AGNs by measuring the PAH 3.3 ${\mu}m$ emission. First, we detected the PAH 3.3 ${\mu}m$ emission from seven out of 27 Seyfert type-1 galaxies at z~0.36. While these galaxies deviate significantly from the local Mbh-${\sigma}$ relation meaning their black holes proceed the host galaxies in terms of evolution, they appear to follow the correlation between nuclear SF and AGN activities of local Seyfert type-1 galaxies. This implies that SF and AGN activities are directly connected at the nuclear region for these Seyfert type-1 AGNs. We also obtained 2-5 ${\mu}m$ spectra for subsamples of Quasar Spectroscopic Observation in Near-infrared Grism (QSONG) which consists of reverberation-mapped AGNs and PG-QSOs. We detected the PAH 3.3 ${\mu}m$ emission from 16 out of 31 reverberation-mapped AGNs and 10 out of 49 PG-QSOs and measured their line strengths. We present the correlations between SF and AGN activities and discuss if there is any dependency of the correlations on properties of host galaxies, such as morphology, or the presence of radio jets.

개복 위절제술에 경험이 풍부한 술자에 의한 복강경 보조하 원위부 위절제술의 Learning Curve

김지훈,정영수,정오,임정택,육정환,오성태,박건춘,김병식,Kim, Ji-Hoon,Jung, Young-Soo,Jung, Oh,Lim, Jeong-Taek,Yook, Jeong-Hwan,Oh, Sung-Tae,Park, Kun-Choon,Kim, Byung-Sik 대한위암학회 2006 대한위암학회지 Vol.6 No.3

목적: 조기위암 치료에 있어서 복강경 위암 수술이 새로운 패러다임으로 정착하고 있다. 기존에 시행하고 있던 개복에 의한 위절제술에 익숙한 경험 많은 외과의사들은 복강경 위암 수술은 시간이 많이 소요되며 기술적으로 습득하는데 많은 제약이 있음을 느끼며 복강경 수술에 소극적 자세를 취하는 경향이 있다. 이에 저자 등은 개복 위절제술에 경험이 풍부한 외과의사에 의한 복강경 위절제술의 learning curve를 결정하고, 이에 영향을 미치는 요인들을 분석하였다. 대상 및 방법: 2005년 4월부터 2006년 3월까지 한 명의 술자에 의하여 수술전 조기 위암(cT1N0)으로 진단 받고 복강경 보조하 원위부 위절제술(LADG) 및 $D1+{\beta}$ 림프절 곽청을 시행 받은 62명을 대상으로 하였으며 복강경 위절제술 시행을 위하여 전문팀을 구성하였다. 대상 환자를 6명씩 한 그룹으로 총 10그룹(마지막 그룹은 8명으로 구성함)으로 나누어 각 그룹의 평균 수술시간을 비교하여 learning curve 극복 전후의 나이, 성별, 수술 후 합병증, 절개창의 길이, 수혈유무, 적출된 림프절 개수, 수술 전 후 혈색소 변화 등을 분석하였다. 결과: 평균 수술 시간을 분석한 결과 여섯 번째 그룹 (31st case)부터 수술 시간의 Plateau를 보였다. 이에 저자들은 learning curve 극복시점을 30th case (7개월)로 간주하였으며 극복 전후 집단 간의 평균 수술시간을 분석하였을 때 각각 $239.0{\pm}69.7$분과 $170.0{\pm}32.6$분으로 유의하게 나타났다(P<0.05), 양 군 간 평균나이, 성별, BMI, 수술 전후의 혈색소 수치변화, 적출된 림프절 개수 등은 유의한 차이를 보이지 않았다. 또한 절개창의 길이, 수혈유무, 수술 후 합병증 유무도 양 군 간에 통계적으로 유의하지 않았다. 결론: 저자들의 LADG learning curve 극복은 30예(7개월)로 다른 보고보다 일찍 도달할 수 있었다. 이는 개복 수술의 풍부한 경험, 전문 수술팀 구성, 그리고 단기간 집중적인 시술에 의한 것으로 생각된다. Purpose: The laparoscopy assisted gastrectomy has been increasingly reported as the treatment of choice for early gastric cancer. However, expert surgeons, who have performed a conventional open gastrectomy for a long time, tend to have a negative attitude toward laparoscopic procedures. The aim of this study was to determine the learning curve of a laparoscopy assisted distal gastrectomy (LADG) for a surgeon expert in performing an open gastrectomy and to analyze the factors that have an effect on a LADG. Materials and Methods: Between April 2005 and March 2006, 62 patients underwent a LADG with D1+beta lymph-node dissection. The 62 patients were divided into 10 sequential groups with 6 cases in each group (the last group was 8 cases), and the time required to reach the plateau of the learning curve was determined by examining the average operative times of these 10 groups. Other factors, such as sex, BMI, complications, transfusion requirements, the number of retrieved lymph nodes, and change of postoperative hemoglobin level, were also analyzed. Results: With the $5^{th}$ group (after 30 cases), the operative time reached a plateau (average: 170 min/operation). The differences between before the $30^{th}$ case and after the $31^{st}$ case with respect to changes in the postoperative hemoglobin level, the number of retrieved lymph nodes, the transfusion requirements, and the complications rate were not significant. Conclusion: According to an analysis of the operative time, experience with 30 LADGs in patients with early gastric cancer is the point at which the plateau of the learning curve (7 months) is reached. Abundant experience with a conventional open gastrectomy and a well-organized laparoscopic surgery team are important factors in overcoming the learning curie earlier.

후포분지 홀로세 퇴적물의 유기물에 대한 지화학 분석 결과 및 의미

김지훈,박명호,공기수,한현철,정태진,최지영,김진호,강무희,이치원,오재호,Kim, Ji-Hoon,Park, Myong-Ho,Kong, Gee-Soo,Han, Hyun-Chul,Cheong, Tae-Jin,Choi, Ji-Young,Kim, Jin-Ho,Kang, Moo-Hee,Lee, Chi-Won,Oh, Jae-Ho 대한자원환경지질학회 2010 자원환경지질 Vol.43 No.1

Geochemical approaches on the two recovered piston cores were performed to understand the characteristics of organic matters and the influence of the sea level variation of the East Sea in the Hupo Basin since the Holocene. The analyzing results on organic components (TOC and TN), and isotopic compositions of organic matters showed the variation to core locations and sampling depths. In core 08HZP-01, their values were gradually changed with depth from 4 mbsf to seafloor. However, rapid variation was observed at the boundary of 4.71 mbsf (meter below seafloor) in core 08HZP-03. Based on TOC/TN, $\delta^{13}C_{org}$ and $\delta^{15}N_{org}$, the origin of organic matters in the Hupo Basin can be divided into three groups; 1) predominant marine algae, 2) $C_3$ land plant, and 3) mixture of $C_3$ land plant and marine/freshwater algae. It is likely that the vertical and spatial variations of organic and isotopic compositions reflect the shifts in sedimentary environment (including sediment transportation) by ocean currents and sea-level changes and others during the Holocene period. 동해안의 후포분지에서 채취한 두 개의 피스톤 코어를 이용하여 후포분지에서의 홀로세 퇴적물 내 유기물의 특징 및 동해 해수면 변화와의 관계를 규명하고자 지화학적 접근을 시도하였다. 채취한 시료에 대한 유기물 성분 분석(TOC와 TN)과 유기물 동위원소($\delta^{13}C_{org}$와 $\delta^{15}N_{org}$) 분석 결과들은 코어와 시료 채취 심도에 따라 분석값들이 특징적으로 변화한다. 코어 08HZP-01에서는 4 mbsf(meter below seafloor)에서 코어 표면까지 비교적 채취 심도가 상부로 갈수록 지화학 분석값들이 점이적으로 증가하지만, 코어 08HZP-03에서는 4.71 mbsf를 기준으로 상부와 하부에서 급격한 지화학 분석값들의 변화가 발생한다. 유기물의 TOC/TN과 $\delta^{13}C_{org}$와 $\delta^{15}N_{org}$의 값을 종합적으로 고려하였을 때, 후포분지의 유기물은 해양 조류 기원이 우세한 집단, $C_3$ 육성 식물 기원이 우세한 집단, 해성/육성 조류와 $C_3$ 육성 식물의 혼합기원이 우세한 집단으로 구분할 수 있다. 이러한 퇴적물 내 유기물의 심도에 따른 특성 및 기원 변화는 주로 홀로세 동해 해류와 해수면 등의 변화에 따른 퇴적환경 변화 (퇴적물 이동 포함)에 기인한 것으로 보인다.