선천성 식도 폐쇄에서 위관을 이용한 식도 치환술의 성적

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

The history of esophageal replacement in infants or children is the history of development of various kinds of alternative conduits such as stomach, colon, and small bowel. The gastric tube has been the most widely used conduit. From January 1988 to May 2003, 23 esophageal replacements with gastric tube were performed at the Department of Pediatric Surgery, Seoul National University Childrens Hospital. Statistical analysis was performed using Windows SPSS11.0 Pearson exact test. There were Gross type A(n=10), type B(n=1), type C(n=11), type D(n=1). Ten patients who had long gap esophageal atresia (type A-8, type B-1, type C-1) and 13 patients (type A 2, type C-10, type D-1) who had stenosis, leakage, recurred tracheoesophageal fistula, and esophagocutaneous fistula after previous corrective operations, had esophageal replacement with gastric tube. Mean follow-up periods were 4 year 2 months (7 months-15 year 1 month). There were postoperative complications including GERD in 16 (69.6 %), leakages in 7 (30.4 %), diverticulum at anastomosis in 2 (8.7 %), anastomosis site stenosis in 4 (17.3 %), and distal stenosis of the gastric tube in 1 (4.3 %). There was no statistical significance between operation types and postoperative leakage and gastroesophageal reflux. In conclusion, esophageal replacement with gastric tube may be a useful surgical option in esophageal atresia with long gap and esophageal atresia complicated by previous corrective operation.

심한 협착이 동반된 크론병 환자에서 인플리시맵 치료 후 발생한 소장 천공

임창섭 ( Chang Sup Lim ),문원 ( Won Moon ),박선자 ( Seun Ja Park ),박무인 ( Moo In Park ),김형훈 ( Hyung Hun Kim1 ),김종빈 ( Jong Bin Kim ),최정문 ( Jeong Moon Choi ),장희경 ( Hee Kyung Chang ),이승현 ( Seung Hyun Lee ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.3

Crohn`s disease is characterized by chronic transmural inflammation of the bowel and is associated with serious complications, such as bowel strictures, abscesses, fistula formation, and perforation. As neither medical nor surgical therapy provides a cure for Crohn`s disease, the primary goals of therapy are to induce and maintain remission and prevent complications. As a biologic agent, infliximab, a monoclonal antibody to tumor necrosis factor, is indicated for refractory luminal and fistulizing Crohn`s disease that does not respond to other medical therapies or surgery. Infliximab has proven to be very effective for inducing and maintaining remission in Crohn`s disease; however, infliximab treatment has several potential complications. Here, we report a case of free perforation following a therapeutic response after an initial dose of infliximab for Crohn`s disease. This is the first case report describing a free perforation in a Crohn`s disease patient after an initial dose of infliximab. (Korean J Gastroenterol 2013;62:169-173

간내결석증의 최근 치료경험 및 장기 치료성적 분석

임창섭(Chang-Sup Lim),장진영(Jin-Young Jang),이승은(Seung Eun Lee),강미주(Mee Joo Kang),김선회(Sun-Whe Kim) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.1

Purpose: Treatment of hepatolithiasis is difficult because of the high recurrence rate, and the long-term outcome is not satisfactory. We reviewed clinical outcomes to determine the optimal treatment modalities for hepatolithiasis. Methods: Between 1981 and 2005, 648 patients with hepatolithiasis were treated at our institute. Changing patterns of treatment modalities and outcomes were analyzed for the periods: 1st (1981∼1985; n=159), 2nd (1986∼1990; n=100), 3rd (1991∼1995; n=111), 4th (1996∼2000; n=141), and 5th (2001∼2005; n=137). Clearance and recurrence rates according to the treatment modalities and associated malignancies were analyzed in patients for the most recent 10 years. Results: During the past 25 years, hepatectomy as a treatment for hepatholithiasis has increased in frequency and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased in frequency. With improvement in operative clearance and post-operative lithotripsy, the final clearance rate improved from 79.0% to 91.3%. In the most recent 10 years, the final clearance rate of hepatectomy, choledocholithotomy, cholangioenterostomy, and PTCS was 97.1%, 82.0%, 78.8%, and 100%, respectively, and the recurrence rate was 34.7%, 15.4%, 17.0%, and 42.9%, respectively. Twenty-six patients (47.2%) had recurrences within 2 years, and 12 patients (21.8%) had recurrences after 5 years. Cholangiocarcinomas occurred in 10 patients (3.6%). The diagnosis of cholangiocarcinoma was established pre-operatively in 2 patients, post-operatively in 4 patients, and during the follow-up period in 4 patients. Conclusion: In the treatment of hepatolithiasis, hepatectomy has a high clearance rate and a low recurrence rate. To reduce the recurrence rate, complete stone clearance without residual stones seems to be of utmost importance. Suspicion of malignancy and long-term follow-up are needed in the management of patients with hepatolithiasis.

간내결석증의 외과적 치료경험

임창섭(Chang-Sup Lim),장진영(Jin-Young Jang),김선회(Sun-Whe Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1

Hepatolithiasis is characterized by its intractablity and frequent recurrence that requires multiple operative and non-operative interventions. To clarify the optimal treatment modalities and their effectiveness, a total of 648 patients with hepatolithiasis and who had treated at Seoul National University Hospital between January 1981 and December 2005 were analyzed according to the different time periods. Hepatectomy as a primary treatment of hepatolithiasis has gradually increased and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased. New treatment modalities such as percutaneous choledochoscopic stone removal (PTCS) and laparoscopic liver resection were instituted during the past decades. Over the last 25 years, both advances in the operative stone clearance rate and the success rate of postoperative lithotripsy have resulted in an improved final stone clearance rate, and this has been progressive from 79.0% in the first period to 91.3% in the fifth period. In the last 10 years, the final clearance rate of hepatectomy, choledocholithotomy, drainage procedures and PTCS was 97.1%, 82.0%, 78.8% and 85.7%, respectively, and the rate of performing repeated hepatectomy, choledocholithotomy, drainage procedures and PTCS was 11.2%, 26.2%, 9.1% and 28.6% respectively. Hepatolithiasisassociated cholangiocarcinomas were found in 24 (4.7%) patients (1991-2005, n=512), and 5 of them were diagnosed after 5 years of follow-up. Histopathologic examinations of the resected livers showed various degrees of pathologies from proliferative cholangitis and hyperplasia through dysplasia and cholangiocarcinoma. Therefore, a suspicion of malignancy and long term follow-up are needed for managing the patients who suffer with hepatolithiasis.

증례 : 신장 ; 성인에서의 신우요관이행부폐색의 1예

임창섭 ( Chang Sup Lim ),김봉진 ( Bong Jin Kim ),김자영 ( Ja Young Kim ),허진 ( Jin Heo ),최원혁 ( Won Hyuk Choi ),홍정범 ( Joung Boom Hong ),허동 ( Dong Heo ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S

신우요관이행부폐색은 태아, 신생아, 소아에서 상부요로 폐색을 일으키는 가장 흔한 기형으로 약 30~50%가 출생 전에 이미 진단되나 성인에서도 드물게 발견되는 경우도 있다. 소아에서의 진단은 초음파를 통하여 우연히 수신증이 발견 되거나, 요로감염 및 발열, 복부 및 측복부 동통, 종물의 촉지등의 증상으로 인해 발견되지만, 성인에서는 장기적으로 무증상을 보이다가 측복부 동통, 혈뇨 등이 나타나면서 진단되며, 일생 동안 증상이 없는 경우도 있다. 장기간의 측복부 동통을 주소로 내원하여 신우요관이행부폐색으로 진단된 성인의 1예가 있어 문헌고찰과 함께 보고하는 바이다. Ureteropelvic junction obstruction is the most common congenital anomaly and causes upper urinary tract obstruction in fetuses, neonates, and children, of which 30~50% is diagnosed before birth and rarely diagnosed in adults. In childhood, a ureteropelvic junction obstruction is usually diagnosed by incidental hydronephrosis on ultrasonography, UTIs, fever, abdominal and flank pain, and a palpable abdominal mass. In adults, a ureteropelvic junction obstruction may be asymptomatic for life or may result in flank pain and/or hematuria. We report a case of chronic flank pain, which was finally diagnosed as a ureteropelvic junction obstruction. (Korean J Med 77:S1253-S1257, 2009)

선천성 비후성 유문협착증

임창섭(Chang Sup Lim),최승훈(Seung Hoon Choi),황의호(Eui Ho Hwang) 대한외과학회 1984 Annals of Surgical Treatment and Research Vol.27 No.4

크론병 환자에서 아자치오프린 용량 적정은 어떻게 할 것인가? 백혈구 정상 하한치와 내약성에 근거한 최대 용량 적정 방법

임창섭 ( Chang Sup Lim ),문원 ( Won Moon ),박선자 ( Seun Ja Park ),박무인 ( Moo In Park ),최정문 ( Jeong Moon Choi ),유재훈 ( Jae Hoon Yoo ),김종빈 ( Jong Bin Kim ),이준식 ( Jun Sik Lee ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.2

목적: 일반적으로 크론병 치료에 있어 체중에 근거한 azathioprine (AZA) 사용(2.5 mg/kg/day)이 권고되고 있지만 많은 환자들에서 골수억제 부작용이 나타나고 있다. 이 연구에서는 크론병 환자에서 관해 유지를 위한 AZA의 최대용량을 체중에 근거하지 않고 백혈구의 정상 하한치에 근거해 적정하는 방법에 대해 알아보고자 하였다. 대상 및 방법: 고신대학교 복음병원에서 크론병으로 진단받은후 2010년에서 2011년까지 고신대학교 복음병원에서 추적 관찰하던 78명의 크론병 환자들 중 내약성과 4,000/mm3 이상의 백혈구 수치를 동시에 만족시키면서 스테로이드 없이 관해를 유지하는 AZA 최대용량을 사용하는 환자들을 연구에 포함시켰다. 적정된 최대용량의 AZA 용량과 체중과의 관계에 대해 살펴보았다. 결과: 총 42명의 환자가 연구에 포함되었으며, 그 중 32명이 남자였고 평균 나이는 31세였다. 내약성과 4,000/mm3 이상의 백혈구 수치를 동시에 만족시키면서 스테로이드 없이 관해를 유지하는 AZA 최대용량은 49.1 mg/day였다. 체중당 용량은 0.87 mg/kg/day였고, 체중당 AZA 용량은 체중(γ=?0.51, p=0.01), 체질량지수(γ=?0.33, p=0.034)와 음의 상관관계가 있었다. 40세 이하 군에서의 체중당 AZA의 용량은 40세 이상 군에서보다 의미있게 많았다(p=0.039). 결론: AZA의 용량을 체중에만 근거하여 결정하는 것은 저용량 또는 고용량의 AZA 용량을 초래하여, 결과적으로 부가적인 치료를 필요로 하거나 심각한 부작용을 일으킬 수도 있다. 따라서, 백혈구의 정상 하한치와 내약성에 근거한 최대용량 적정 방법은 AZA 용량 결정에 있어 새롭고 가치있는 방법이다. Background/Aims: Although general guidelines have suggested weight-based dosing of azathioprine (AZA, 2.5 mg/kg/day) for Crohn`s disease (CD), a substantial number of patients develop bone marrow suppression. The aim of this study was to evaluate the maximum dose of AZA not based on weight but titrated according to the lower limit of leukocyte count for maintaining remission in patients with CD. Methods: Among a total of seventy-eight patients with CD, who had been followed-up at Kosin University Gospel Hospital (Busan, Korea) from 2010 to 2011, those treated with the maximum dose of AZA meeting both drug-tolerability and leukocytes count of more than 4,000/mm3 for steroid-free maintaining remission were enrolled. The titrated maximum AZA dose and its relationship with weight were evaluated. Results: A total of 42 patients (male, 32 patients; mean age, 31 years) were enrolled. The maximum dose of AZA was 49.1 mg/day. The dose per weight was 0.87 mg/kg/day and negatively correlated with body weight (γ=?0.51, p=0.01) and BMI (γ=?0.33, p=0.034). AZA dose per weight in the below 40 years old group was significantly higher than that in the above 40 years old group (p=0.039). Conclusions: Dose decision of AZA based only on weight could put the patients to inappropriately low or high dose resulting in need of additional therapy or serious side effect, respectively. Therefore, the maximum dose-titration based on the lower limit of leukocyte count and tolerability is a novel and a valuable strategy in deciding the dose of thiopurines. (Korean J Gastroenterol 2013; 62:111-116)

외상성 십이지장 손상후 예후에 미치는 요인에 관한 고찰

임창섭(Chang Sup Lim),민현식(Hyun Sik Min),지훈상(Hoon Sang Chi),박기일(Kiil Park),김춘규(Choon Kyu Kim) 대한외과학회 1984 Annals of Surgical Treatment and Research Vol.26 No.4

파열 간세포암에 대해 시행된 외과적 절제술의 성적

이해원 ( Hae Won Lee ),임창섭 ( Chang-sup Lim ),김효신 ( Hyo-sin Kim ) 대한간암학회 2017 대한간암학회지 Vol.17 No.1

Background/Aims: Many recent studies have shown excellent outcomes of surgical resection for ruptured hepatocellular carcinoma (HCC). In addition, there are several reports suggesting that a ruptured HCC did not increase the risk for peritoneal dissemination of a tumor after surgical resection. However, the impact of HCC rupture on recurrence and patient survival has not yet been clarified. Methods: The medical data of patients who underwent surgical resection for ruptured HCC in our center between January 2011 and December 2015 were retrospectively reviewed. The outcomes of the patients were investigated. Results: Among 128 patients who underwent surgical resection for HCC, 5 patients (3.9%) had a ruptured HCC. All patients underwent elective operation in a stable condition. Transarterial chemoembolization (TACE) was performed for achieving hemostasis in four patients except one who achieved spontaneous hemostasis. Two patients had tumor recurrence and one patient died due to HCC recurrence during the median follow-up duration of 28.3 months (range, 24.3-62.3 months). One patient who developed late intrahepatic recurrence at 40.0 months after resection was managed well by means of radiofrequency ablation and TACE and is now alive for 5 years without any evidence of viable tumor. However, the other patient who showed early peritoneal seeding at 1.9 months after resection finally died despite aggressive treatments. Conclusions: Rupture of HCC might result in peritoneal seeding of the tumor in the early postoperative stage, which could lead to a poor result. Nonetheless, surgical resection may be the best treatment option yielding good survival, even for a ruptured HCC. (J Liver Cancer 2017;17:54-59)

개착식터널의 비선형 지진응답해석을 통한 내진성능 연구

김기홍(Kim Ki-Hong),김진섭(Kim Jin-Sup),권민호(Kwon Min-Ho),신홍영(Shin Hong-Young),임창섭(Lim Chang-Sub),이은호(Lee Eun-Ho) 한국철도학회 2009 한국철도학회 학술발표대회논문집 Vol.2009 No.11월

Since occurrence and magnitude of the earthquake in Korea has increasing recently, the safety of public facilities such as underground subway stations and opencut tunnels. Especially, the open cut tunnel section has not been designed to resist the earthquake loads. Therefore, it is needed to investigate the performance of the open cut tunnel against earthquake loads. In this study, linear and nonlinear dynamic analyses with soil-structure interaction have been performed over the several representative open cut tunnel sections to evaluate the structural performance and damages. As a result of analyses, damage distribution of the open cut sections and collapse mechanism were obtained. Results and observations of this study will be used in preliminary design of retrofitting system for damaged structures.