체외막 산소화 요법을 적용한 선천성 횡격막탈장 치료의 초기 경험

김태훈,조민정,박정준,김대연,김성철,김인구,Kim, Tae-Hoon,Cho, Min-Jeng,Park, Jeong-Jun,Kim, Dae-Yeon,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 2011 소아외과 Vol.17 No.2

Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was $38.8{\pm}1.7$ weeks and mean birth weight was $3031{\pm}499$ gram. Mean age at the time of ECMO cannulation was $29.9{\pm}28.9$ hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores ($8.25{\pm}0.96$ vs. $7.00{\pm}1.20$, p=0.109), higher pre ECMO mean pH ($7.258 {\pm}0.830$ vs. $7.159{\pm}0.986$, p=0.073) and lower pre ECMO $PaCO_2$ ($48.2{\pm}7.9$ vs. $64.8{\pm}16.1$, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.

소아외과 영역의 선천성 응급 질환에서 산전 진단이 술후 사망률에 미친 영향

김태훈,이성철,김현영,정성은,박귀원,김우기,Kim, Tae-Hoon,Lee, Seong-Cheol,Kim, Hyun-Young,Jung, Sung-Eun,Park, Kwi-Won,Kim, Woo-Ki 대한소아외과학회 2004 소아외과 Vol.10 No.2

As prenatal ultrasonography becomes popular, the number of prenatal diagnosis of congenital surgical diseases is also increasing. To evaluate the impact of antenatal ultrasonography on outcome the mortality rate in neonatal surgical emergencies was studied. The authors retrospectively reviewed 281 patients (congenital diaphragmatic hernia: 44, tracheoesophageal fistula: 78, intestinal atresia: 98, omphalocele: 28 and gastroschisis: 33 who had been managed at Seoul National University Childrens Hospital, from January 1991 to December 2000. The patients were divided into two groups; group A (1991 to 1995; 139 patients) and group B (1996 to 2000; 142 patients). These two groups were subdivided into prenatally diagnosed subgroup and postnatally diagnosed subgroup. We analyzed the changes of prenatal diagnosis rate, total mortality rate, and mortality rate of subgroups. Prenatal diagnosis rate was increased significantly in group B (Group A: 24.5 % and Group B: 45.1 %). Total mortality rate of group A was 21.6 %, and that of group B was 10.6 %, showing a significant decrease in group B. However, in both group A and B, when compared antenatally diagnosed subgroup with postnatally diagnosed subgroup, the mortality rate was lower in postnatally diagnosed subgroups but statistically not significant. The authors conclude that although prenatal diagnosis rate has been increased, prenatal diagnosis itself has not resulted in significant improvement in outcome.

폐이식 이후에 발생하는 재관류부종의 방사선학적 고찰

김태훈,유영훈,김형중,안철민,백효채,이두연,김상진,Kim, Tae-Hun,Yu, Yeong-Hun,Kim, Hyeong-Jung,An, Cheol-Min,Baek, Hyo-Chae,Lee, Du-Yeon,Kim, Sang-Jin 대한영상의학회 2003 대한영상의학회지 Vol.49 No.4

Purpose: To elucidate the sequential radiologic manifestations of reperfusion edema after lung transplantation. Materials and Methods: The study group comprised five consecutive lung transplant recipients (M:F=3:2; mean age; 47.5 years) who between July 1996 and April 2002 underwent lung transplantation procedures (four, unilateral; one, bilateral) at our institution. We retrospectively reviewed the serial postoperative radiographs obtained and characterized the lung infiltrates. Results: Lung infiltrates compatible with reperfusion edema were present in all patients (5/5). Reperfusion edema appeared on day 1 in four, and by day 2 in the other. In all transplanted lungs, infiltrates were found in the perihilar and basilar regions, and were scored as maximal on day 1 in one, day 3 in two, day 4 in one and day 5 in the other. Conclusion: The recognition of sequential radiological manifestations helps identify recognition of reperfusion edema after lung transplantation. 목적: 본 연구는 폐이식후 재관류부종의 시기에 따른 방사선적 소견을 기술하려고 한다. 대상과 방법: 본원에서 폐이식을 시행받은 5명의 수여자를 대상으로 하였다. 1996년 7월부터 2002년 3월까지 세 명의 남자와 두 명의 여자가 폐이식을 받았고, 평균 연령은 47.5세 였다. 이 중 4 명은 한쪽 폐만 이식을 받았고, 1명은 양폐 이식을 받았다. 모든 수술후 연속적인 수술후 방사선 사진을 분석하고, 폐음영을 기술 하였다. 결과: 재관류부종은 네 명에서는 수술후 1일째에 , 한 명에서는 2일째에 나타났다. 최대치의 폐음영은 한 명에서 수술후 1일에, 두 명에서 수술후 3일째에, 한 명에서 4일째에, 나머지 한 명은 술후 5일째에 있었다. 결론: 재관류부종은 모든 폐이식 이후에 일어나는 현상이며 방사선학적으로는 폐문주위와 하폐에 우세하게 분포하는 미세 망상형 또는 기강경화로 나타나며, 약 5일 이내에 최대 시기를 거치고 3주 이내에 특별한 치료없이 소실된다.

프리캐스트 콘크리트 바닥판을 이용한 합성형교의 설계 및 시공

김태훈,김인규,김영진,김성운,Kim, T.H.,Kim, I.K.,Kim, Y.J.,Kim, S.U. 한국전산구조공학회 2007 전산구조공학 Vol.20 No.2

큐라리노 증후군의 임상 경험

김태훈,조민정,김대연,김성철,김인구,Kim, Tae-Hoon,Cho, Min-Jeong,Kim, Dae-Yeon,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 2011 소아외과 Vol.17 No.1

Currarino syndrome is a hereditary syndrome characterized by the triad of a sacral bony defect, presacral mass and anorectal malformation. We retrospectively reviewed 13 Currarino syndrome patients who were treated in our center between 1997 and 2010. Demographic data, initial symptoms, initial diagnosis. pathologic diagnosis of presacral mass, associated anomalies and managements were analyzed. There were 8 boys and 5 girls. Four patients were diagnosed as Currarino syndrome immediately after birth with failure of passage of meconium and abdominal distension. Four patients underwent surgery for imperforate anus immediately after birth and W8re diagnosed as Currarino syndrome later and underwent reoperation. Three patients were diagnosed during work-up and management with of the tentative diagnosis of Hirschsprung's disease. Diagnosis of the remaining two patients was at the age of 26 months and 9 years and anorectal malformation was not associated. Twelve patients showed hemi-sacrum and one patient showed bilateral sacral subtotal agenesis. Two patients without anorectal malformation underwent presacral mass excision, untethering of spinal cord and repair of myelomeningocele. Six out of 8 patients, excluding 3 that expired or were lost to follow up, with anorectal malformation underwent colostomy, presacral mass excision, untethering of spinal cord, repair of myelomeningocele, posterior sagittal anorectoplasty and colostomy repair. One patient underwent only posterior sagittal anorectoplasty after colostomy. One waits the scheduled operation only with Hegar dilatation. Pathologic examation of presacral masses showed myelomeningoceles in 4 patients, lipomyelomeningoceles in 3 patients and dermoid Cyst in one patient. Teratoma was combined in 2 patients. Eight patients needed neurosurgical operation for spinal cord problems. Seven patients had urologic anomalies and two of them underwent operation. Currarino syndrome should be considered as a differential diagnosis in pediatric patients with abdominal distension, constipation and anorectal malforlnation. For proper evaluation and treatment, a multi-disciplinary approach is recommended.

안의료용 렌즈 적용을 위한 Vinyl Group으로 치환된 Naphthalene 및 Anthracene을 포함하는 고분자 소재의 물성평가

김태훈,김동현,이민제,김득현,노정원,성아영,Kim, Tae-Hun,Kim, Dong-Hyun,Lee, Min-Jae,Kim, Duck-Hyun,No, Jung-Won,Sung, A-Young 대한화학회 2014 대한화학회지 Vol.58 No.2

히크만 카테터를 삽입한 소아 환자에서 발생한 합병증 분석

김태훈,김대연,조민정,김성철,김인구,Kim, Tae-Hoon,Kim, Dae-Yeon,Cho, Min-Jeong,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 2010 소아외과 Vol.16 No.1

Hickman catheters are tunneled central venous catheters used for long-term venous access in children with malignancies. The appropriate management for various kinds of catheter related complications has become a major issue. We retrospectively analyzed the clinical, demographic, and surgical characteristics in 154 pediatric hemato-oncology patients who underwent Hickman catheter insertion between January 2005 and December 2009. There were 92 boys and 62 girls. The mean age at surgery was $7.6{\pm}5.1$ years old. The mean operation time was $67.4{\pm}21.3$ minutes and C-arm fluoroscopy was used in 47(30.5 %). The causes of Hickman catheter removal were termination of use in 82 (57.3 %), catheter related bloodstream infection in 44(30.8 %), mechanical malfunction in 11(7.7 %), and accidents in 6(4.2 %). Univariate and multivariate analysis for associated factors with catheter related bloodstream infection showed that there were no statistically significant associated factors with catheter related infection complications. All cases except two showed clinical improvement with catheter removal and relevant antibiotics treatment. The mean catheter maintenance period in patients of catheter removal without complications was $214.9{\pm}140.2$ days. And, The mean catheter maintenance period in patients of late catheter related bloodstream infection was $198.0{\pm}116.0$ days. These data suggest that it is important to remove Hickman catheter as soon as possible after the termination of use. When symptoms and signs of complications were noticed, prompt diagnostic approach and management can lead to clinical improvements.

고해상도 공간영상을 이용한 자연재해 피해조사시스템 설계 및 구현

김태훈,김계현,남기범,심재현,최우정,조명흠,Kim, Tae-Hoon,Kim, Kye-Hyun,Nam, Gi-Beom,Shim, Jae-Hyun,Choi, Woo-Jung,Cho, Myung-Hum 한국공간정보학회 2010 한국공간정보시스템학회 논문지 Vol.12 No.1

본 연구에서는 최근 활발하게 보급되고 있는 고해상도 영상과 GIS 기술을 활용하여 광역적 자연재해 피해 조사를 위한 피해조사시스템을 개발하였다. 연구 대상지역은 2008년 7월 집중호우로 인해 큰 피해가 발생한 경상북도 봉화군으로 선정하였으며, 시스템 시범적용을 위해 대상지역 중 가장 피해가 큰 춘양면 약 $60km^2$을 중심으로 GIS DB를 구축하였다. GIS DB는 춘양면 일대의 피해 전, 후 항공사진 및 위성 영상과 1:5,000 수치지형도, 1:1,300 연속지적도를 편집 가공하였다. 피해조사시스템은 VB.NET 2005와 공간 연산을 위해 ArcObject 컴포넌트를 이용하여 개발하였으며, MS-SQL을 사용하여 정보전송 및 동기화를 위한 방안을 마련하였다. 세부 프로세스는 피해 전, 후 항공 위성영상을 비교하여 피해지역을 파악하고, 제반 DB와 중첩분석을 통해 해당 피해항목의 피해규모와 피해추정액을 자동으로 산출되도록 하였다. 고해상도 영상기반의 자연재해 피해조사시스템은 광역적 피해지역에 대하여 객관적이고 정확한 피해정보를 소수의 전문 인력을 통해 신속하게 산출할 수 있으며, 이에 따른 복구예산의 조기편성 및 응급대응책 마련에 효율적이다. 또한 피해정보의 손쉬운 관리와 전산화된 데이터를 통해 피해예방계획 수립에 있어서도 활용 가능 할 것이라 생각되며, 궁극적으로 IT 기반의 유비쿼터스 방재시스템 개발에 효율적으로 활용 가능할 것이라 사료된다. 추후 더욱 효율적인 시스템 운영을 위해서 산출된 피해정보의 전자재해대장 연계를 통한 지속적인 방재 DB 구축 방안 마련이 필요하다. In this study, disaster damage investigation system was developed using high resolution satellite images and GIS technique to afford effective damage investigation system for widely disaster damaged area. Study area was selected in Bonghwa, Gyungsangbukdo where high magnitude of damages from torrential rain has occurred at July in 2008. GIS DB was built using 1:5,000 topographic map, cadastral map, satellite image and aerial photo to apply for investigation algorithm. Disaster damage investigation system was developed using VB NET languages, ArcObject component and MS-SQL DBMS for effective management of damage informations. The system can finding damaged area comparing pre- and post-disaster images and drawing damaged area according to the damage item unit. Extracted object was saved in Shape file format and overlayed with background GIS DB for obtaining detail information of damaged area. Disaster damage investigation system using high resolution spatial images can extract damage information rapidly and highly reliably for widely disaster areas. This system can be expected to highly contributing to enhance the disaster prevention capabilities in national level field investigation supporting and establishing recovery plan etc. This system can be utilized at the plan of disaster prevention through digital damage information and linked in national disaster information management system. Further studies are needed to better improvement in system and cover for the linkage of damage information with digital disaster registry.

고속 월쉬 변환을 이용한 이동 유체간 열교환 상태 해석에 관한 연구

김태훈,이승,Kim, Tae-Hoon,Lee, Seung 한국조명전기설비학회 2001 조명·전기설비학회논문지 Vol.15 No.6

분포정수계는 시스템이 두 개 이상의 독립변수로 표현되면서 또한 각 변수에 대한 미분을 포함하는 편미분 방정식으로 표현되므로, 분포정수계에 직접적인 최적제어 논리를 도입하는 것은 매우 어렵다. 본 연구에서 제시하고자하는 새로운 알고리즘은 월쉬 함수 고유특성을 그대로 유지할 수 있는 유한급수전개방법을 이용함과 동시에 계산의 편리성을 위하여 고속 월쉬 변환을 사용하는 것으로서, 본 연구 방법을 사용하면 역행렬 연산이 필요 없게 되므로 기존의 방법에 의해 처리하기 힘든 분포정수계, 선형시변계, 비선형계의 해석 및 제어문제어도 쉽게 적용할 수 있다. This study uses the distributed parameter systems resented by the spatial discretization technique. In this paper, the distributed parameter systems are converted into lumped parameter systems, End fast Walsh transform and the Picard's iteration method are allied to analysis the state of the systems. This thesis presents a new algorithm which usefully exercises the optimal contro1 in the distributed parameter systems. In exercising the optimal control of the distributed parameter systems, the excellent consequences are found without using the existing decentralized contro1 or hierarchical control method. This study can be applied to the linear time-varying systems and the non-linear systems. Farther researches are required to solve the problems of convergence in case of the numerous applicable intervals. The simulation proves the effectiveness of the proposed algorithm.

OGC기반 도시공간정보 데이터 연동서비스를 위한 상호연계기술 개발 연구

김태훈,김성수,홍창희,황정래,Kim, Tae Hoon,Kim, Seong Su,Hong, Chang Hee,Hwang, Jung Rae 대한공간정보학회 2013 한국공간정보학회지 Vol.21 No.1

최근 u-City, Smart city 등 첨단도시를 구축하려는 다양한 움직임이 있으며, 이러한 첨단도시의 기반인프라로서 공간정보가 필수적인 요소로 인식되고 있다. 그러나 많은 경우에 있어서 기존에 구축된 공간정보 즉 GIS 데이터는 포맷의 다양성으로 인한 자료간 호환성 부족으로 기관간 상호연계 및 대국민 웹서비스 등에서 어려움을 겪어왔다. 이에 본 연구에서는 이기종 분산환경에서 기 구축되어 활용되고 있는 GIS 및 UIS 데이터를 국제표준인 OGC(Open Geospatial Consortium) 표준기반으로 상호연동할 수 있도록 중계역할을 해주는 상호연계서버를 개발하고, 테스트베드 적용을 통해 성능을 검증하였다. 해당 성과는 향후 첨단도시의 통합관제플랫폼 및 화산재해대응플랫폼 등에 적용되어 기 구축 DB의 활용성을 제고하고 시스템의 효율성을 높일 수 있으리라 기대된다. Recently, there are various attempts to construct a u-City and a smart city. A Spatial information as the city-based infrastructure has been recognized as an essential element. In many cases GIS data being lack of compatibility due to the various format, it is difficult to provide public web services and link the data between government organizations. In this study, we developed a interconnection Server based on OGC standardization to support interoperability in a heterogeneous distributed environment. we hope the interconnection server that will be utilized as u-City platform and response platform for volcanic disaster through the test in the test-bed.