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심실중격결손이 동반된 폐동맥폐쇄에서 폐혈류 공급원에 따른 특징 및 체폐단락술후 폐동맥의 변화
남기세,김정훈,최재영,설준희,이승규,박영환* 대한소아청소년과학회 2004 Clinical and Experimental Pediatrics (CEP) Vol.47 No.3
Purpose:The purpose of this study is to help determine the optimal time and method for operation of pulmonary atresia(PA) with ventricular septal defect(VSD). Methods:Seventy patients who were diagnosed as PA with VSD in the Pediatric Department of Cardiology, Severance Hospital between May, 1991 and April, 1995, were included in our study. Subjects were divided into two groups depending on the presence of major aorto-pulmonary collateral arteries(MAPCAs). In patients with MAPCAs, the distribution of MAPCAs concerning its relationship with central PA were analyzed, while in patients without them, morphologic changes of PA after performing conventional modified Blalock-Taussig(B-T) shunt were studied. Results:After performing modified B-T shunts, the number of cases of PA stenosis and interruption increased from 26 to 37. Fifteen cases of advanced stenosis and six cases of interrupted PA were also observed. After performing modified B-T shunt, CSAI of both PA was increased from 197±101 to 311±138, more remarkably in cases without progression of PA stenosis. Among the patients with MAPCAs, 12 cases showed PDA, while 16 cases showed confluent PA. On average, MAPCAs were present in 2.5 cases. Concerning the types of MAPCAs, 14 cases were unifocal, while 36 cases were multifocal and most of them originated from descending aorta. Conclusion:In cases where pulmonary flow is maintained by PDA, stenosis of central PA is common, and can result in retarded pulmonary arterial development or increased stricture after modified B-T shunt, so careful attention is needed during follow-up. In cases with dominant MAPCAs, confluent PA is common, and multifocal pulmonary supply renders surgery difficult, so careful analysis of pulmonary supplies to each pulmonary segments, their shapes and relationships, are indicated preoperatively 목 적 : 팔로씨 4징형의 심실중격결손이 동반된 폐동맥폐쇄는 폐동맥의 형태 및 폐혈류 공급원이 다양하고 동맥관과 폐동맥의 연결 부위의 협착은 진행하는 수가 많으며 또한 단락수술 후의 협착의 진행은 예상할 수 있어, 환아의 수술방법과 시기를 결정하는데 도움이 되고자 본 연구를 시행하였다.방 법 : 1991년 5월부터 1995년 4월까지 연세심장혈관센터 소아심장과에서 심도자검사 후 심실중격결손이 동반된 폐동맥폐쇄로 진단받은 70례를 대상으로 하여 체폐측부동맥이 없는 군은 일차적 고식수술인 체폐단락술 후에 유발된 폐동맥의 변화양상을 형태학적 분류에 따라 비교하고 체폐측부동맥이 있는 군은 이들의 분포와 중심폐동맥과의 관계를 비교하였다.
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남기세,김종민,정기섭,한석주,Nam, Ki Se,Kim, Jong Min,Chung, Ki Sup,Han, Seok Joo 대한소아소화기영양학회 2004 Pediatric gastroenterology, hepatology & nutrition Vol.7 No.2
영아에서 담관의 자연 천공은 매우 드물며 조기에 발견하여 치료하지 않으면 사망할 수 있는 질환이다. 출생 후 건강하던 영아가 복부팽만, 복수, 황달이 나타나면 의심하게 되며 대부분 수술적 담도 조영술을 시행하는 과정에서 진단된다. 저자들은 복부팽만, 황달, 무담즙변 증상이 있는 생후 4개월 된 소아에서 총담관의 자연천공 1례를 경험하여 문헌 고찰과 함께 보고하는 바이다. Spontaneous perforation of the biliary duct is a rare disease that must be treated immediately when diagnosed in infancy. This disease must be suspected in a previously healthy infant who suddenly has abdominal distension, ascites, and intermittent jaundice. The best way to diagnose the leakage of bile in a clinically stable infant is to use radionuclide hepatobiliary scan. In most cases, however, the diagnosis of the perforation of common bile duct is frequently made during the procedure of operative cholangiogram. The prognosis is usually good with early diagnosis. We experienced an infant of 4 months of age who presented with sudden abdominal distension, jaundice and acholic stool, and confirmed the diagnosis of perforation of common bile duct through operative cholangiogram with t-tube insertion. We report a case of spontaneous perforation in an infant with review of the literatures.
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정필현,황정수,강석,남기세,배호균 대한골절학회 1999 대한골절학회지 Vol.12 No.2
Fracture of the ankle is one of the most common fractures. Usually medial malleolar fractures, when non-displaced or minimally displaced, have been treated by closed reduction and cast immobilization for long period, so stiffness and osteoporosis of ankle were frequently inevitable. We investigated the result of percutaneous pinning or screw fixation and early mobilization in the treatment of medial malleolar fracture of the ankle. With clinical and radiological data, authors analysed 17 patients(17 ankles) who were treated with closed reduction and percutaneous pinning or screw fixation between August 1991 and May 1997. and following results were obtained. One case of pin site infection was noted and no nonunion or loss of fixation was identified and average duration of bone union was 12 weeks. According to Burwell's protocol, the good result are 16 cases, the fair is 1 case and the poor result is not observed. From the viewpoint of rehabilitation, authors consider percutaneuos pinning is an excellent plan of treatment of medial malleolar fractures, when non-displaced or minimally displaced.
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비구골 결손부위에 동종골 이식을 이용한 비구측 재치환술의 결과
김영민 ( Young Min Kim ),김희중 ( Hee Joong Kim ),강승백 ( Seung Baik Kang ),남기세 ( Ki Se Nam ) 대한고관절학회 1993 Hip and Pelvis Vol.5 No.2
Loosening of the acetabular component of a total hip prosthesis with the concomitant loss of acetabular bone stock has become an important problem. Several techniques have been devised to compensate for the acetabular bone defect. These include the use of additional bone cement and the use of autograft or allograft in conjunction with bipolar endoprosthesis or micropore or hydroxyapatite coated acetabular cup or acetabular reinforcement ring. At Seoul National University Hospital, allograft without cement or acetabular ring has been used to fill the defect of acetabulum in hip revision arthroplasty since November, 1988. Initially bipolar endoprosthesis was used as an implant, but later hemispherical porous coated or hydroxyapatite coated cup with screw fixation were used. Total thirty eight hips ( bipolar endoprosthesis 12 cases, THRA 26 cases ) were followed more than one year. In these cases, the amount of migration of cup, which was measured by using the tear drop as a base, and the Harris score were analyzed. The results are summerized as follows l. In bipolar hemiarthroplasty of total 12 cases, the average duration of follow-up was 2 year. The Harris score was improved from 58.1 preoperatively to 67.9 postoperatively. During the follow-up, cup migrations were developed in 8 cases (67%) and cup migrations were progressed over 6 months in 7 cases (58%) and they were comsidered to be the candidates for revision and the remains were comsidered satisfactory. 2. In total hip replacement arthroplasty of taotal 26 cases, the averag duration of follow-uo was 1 year 3 months. The Harris score was improved from 58.9+ prepoperatively to 74.6 postoperatively. During the foolow-cup, cup migration were devepoped in 10 cases (38%) and the migration were progressed in 5 cases (19%) and 2 cases of them were revised because of loosening and the other 16 cases were considered satisfactory. 3. The cases were analized accordign to the of the deficiencies of the acetabulum, When bipolar hemiarthroplasty was done at the acetabulum with superolateral bone stock, in the three were of eight cases progressive migration was occured. And without superolateral bone stock, progressive cup migrations were noticed in the all of four cases. But, when cementless THRA was done at the acetabulum with intact superolateral bone stock, there were no cases cup failure and when THRA was done at the acetabulum without superolateral bone stock, in the five of eight cases of cup failure were occured. So, in cup revision arthroplasty for acetabular bone defectm THRA with screw fication os more reliabelmethod than that of cipolar cup. When superir and/or lateral segmental defect in acetabulum os present, neither revision with bipolar nor THRA show better result. In that case, the reinforcement procedure is mandatory.
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