기관 식도루가 없는 식도폐쇄증 환자의 치료경험

김성민,최승훈,김성훈,권인규,한석주,오정탁,Kim, Seong-Min,Choi, Seung-Hoon,Kim, Sung-Hoon,Kwon, In-Kyu,Han, Seok-Joo,Oh, Jung-Tak 대한소아외과학회 2005 소아외과 Vol.11 No.2

Esophageal atresia without tracheoesophageal fistula accounts for 7-11 % of all types of esophageal atresia and is very difficult to treat. In our hospital from 1990 to 2005, we operated upon 40 patients with esophageal atresia, and 6 had pure atresia. The preoperative characteristics, operative findings and post operative course of the six patients with pure atresia were analysed. Immediate gastrostomy was performed in all 6 patients. One patient had simultaneous cervical esophagostomy. Esophageal reconstruction procedures were transhiatal gastric pull up in 3 patients, esophagocologastrostomy utilizing left colon in 1, and transthoracic esophagoseophagostomy with esophageal bougination in 2. Postoperative complications were pneumonia, anastomosis leakage, and gastroesophageal reflux symptom. Conservative management was effective in all patients. A larger series of cases would be required to demonstrate the most effective treatment for this particular anomalous condition. 1990년 1월부터 2005년 5월까지 연세대학교 의과대학 세브란스 병원 소아외과에서 기관식도루가 없는 식도폐쇄증으로 진단받고 수술을 시행받은 6예의 환자의 수술전후 임상상을 검토하였다. 이들의 빈도는 같은 기간동안 수술받은 식도폐쇄증 환자의 약 15 %였으며, 이들 6예 모두에서 단계적인 수술로 상부식도와 하부식도를 연결하는 수술을 성공적으로 시행하였으며(위전위법 3명, 대장전위법 1명, 자가식도 단단문합 2명), 수술 후 추적관찰시 양호한 소견을 보였다. 식도의 부우지 확장을 수차례 시행한 후 식도단단문합이 가능한 환자는 이 방법이 가장 좋을 것으로 생각되며, 자가식도의 1차적인 단단문합이 성공하기 위한 수술전식도 부우지확장의 적절한 횟수와 정도에 대한 연구가 되어야 할 것이다. 타 장기를 이용한 식도재건술 후에 발생할 수 있는 수술직후의 폐렴, 문합부 누출이나 식도 협착, 위식도 역류증상 등에 대하여서도 그 빈도를 줄일 수 있는 수술방법에 대한 지속적인 연구가 필요할 것으로 생각된다.

윌름씨 종양의 치료 및 장기간 추적관찰 결과

김성민(Seong Min Kim),오정탁(Jung Tak Oh),한석주(Seok Joo Han),최승훈(Seung Hoon Choi) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.71 No.3

세포고사 억제 유전자 Survivin의 발현과 신경모세포종의 예후

안수민(Soo Min Ahn),오정탁(Jung-Tak Oh),한석주(Seok Joo Han),황의호(Eui Ho Hwang),최승훈(Seung Hoon Choi) 대한외과학회 2005 Annals of Surgical Treatment and Research(ASRT) Vol.68 No.1

비만지표(肥滿指標)와 사상인체질분포(四象人體質分布)와의 관계(關係)에 관한 림상보고(臨床報告)

유호상 ( Ho Sang You ),최승훈 ( Seung Hoon Choi ),오민석 ( Min Seok Oh ),송태원 ( Tae Won Song ) 한방재활의학과학회 2002 한방재활의학과학회지 Vol.12 No.3

Objectives:To find out the correlation between indices related with obese and sa-sang constitutional distribution Methods:This study was done with 38 persons, who had taken the tests for obese and sa-sang constitutional distribution in oriental medical hospital of Dae Jeon university from 22 February 2002 to 2 April 2002.Then, the data of % body fat, obesity degree, BMI, WHR and BMR was analyzed by sex, age and sa-sang constitutional distribution.Results:The correlation between % body fat, obesity degree, WHR and BMI & sex had no significance with a exception of BMR (Sig.=0.000).and the habit of drinking had no significant correlation with the indices but smoking did with BMR(Sig.=0.011).In obesity degree, Taeeum-in had significant differences compared with soyang-in and soeum-in, in BMI and WHR Taeeum-in compared significantly with soeum-in and in BMR Taeeum-in did with soyang-in.Conclusions:Indices for obesity with a exception of % body fat had significance with sa-sang constitutional distribution especially for Taeeum-in.

소아환자에서 대복재정맥을 통한 하대정맥도관법의 유용성

김승환,김성민,오정탁,한석주,최승훈,Kim, Seung-Hwan,Kim, Seong-Min,Oh, Jung-Tak,Han, Seok-Joo,Choi, Seung-Hoon 대한소아외과학회 2006 소아외과 Vol.12 No.2

Central venous catheter (CVC) for long-term venous access is indispensable for various reasons including hyperalimentation, frequent blood sampling, frequent IV drug use in pediatric patients. We report clinical experience of surgical neonates in whom CVC was inserted primarily via great saphenous vein into suprarenal inferior vena cava. From March 2004 to March 2006, we performed CVC insertion via saphenous vein - contralateral side to main wound - into suprarenal inferior vena cava in surgeries of neonates. 2.7Fr or 4.2Fr, single lumen, tunneled Broviac catheters (Bard Access system, Inc, Salt Lake City, Utah) were used. Skin exit site of tunneled catheter was located in ipsilateral flank area just below edge lower rib. At the end of the procedure, location of the catheter tip was confirmed by plain radiography of abdomen. We retrospectively reviewed the admission records of the patients including nursing staff charts. Nine (50.0 %) patients were male and nine (50.0%) were female. Median gestational age was 38 weeks (range, 29-42 weeks) and median birth weight was 3,105 gm (range, 1,040-3,720 gm). Median age at catheter insertion was 38.5 days (range, 1-236 days). The purpose of CVC insertion was short-and long-term hyperalimentation in nine (50.0 %) patients. CVC insertion was performed in operation room under general anesthesia in sixteen (88.9 %) patients (in these cases, CVC insertion was performed just prior to concurrent operation) and neonatal intensive care unit (NICU) under local anesthesia with adequate sedation in two (11.2%). During the admission period (total catheter-indwelling time: 553 days), CVC functioned well without any significant side effects. Transient swelling of the ipsilateral leg (n=1, 5.6 %) and transient migration of catheter tip (n=1, 5.6 %) were noted, which did not affect function of the indwelled CVC. Mean catheter-indwelling time was 30.7days (range, 3-72 days). All catheters were removed electively except two mortality case. Complications, such as thrombosis, infection, kinking or extravasation of drugs, were not observed in our study period. Tunneled trans-great saphenous vein inferior vena cava catheters are not only comparable to cervical CVCs in terms of function and complication rates, but also very beneficial in selected patients, especially those in whom cervical approach is technically impossible or contraindicated.

이탈된 위루관에 대한 투시경하 변형 Seldinger씨 방법을 이용한 경피적 위루관 재삽입술

김주희,김성민,오정탁,최승훈,황의호,한석주,Kim, Joo-Hee,Kim, Seong-Min,Oh, Jung-Tak,Choi, Seung-Hoon,Hwang, Eu-Ho,Han, Seok-Joo 대한소아외과학회 2006 소아외과 Vol.12 No.2

This case report describes a baby who received a laparoscopic gastrostomy tube insertion, which was dislodged accidentally at $16^{th}$ postoperative day. After the dislodgement, cutaneous tract rapidly closed, and reinsertion seemed to be impossible. However, gastrostomy tube was reinserted safely with fluoroscopy-guided Seldinger's technique under local anesthesia with sedation. This is the unique method of modified Seldinger's technique for reinsertion of gastrostomy tube under local anesthesia and sedation for accidentally dislodged gastrostomy tube. This method was thought to be safe, easy and useful technique for gastrostomy reinsertion after dislodgement of gastrostomy tube.

소아의 췌장의 고형성 가유두상 종양

김성민,오정탁,한석주,최승훈,Kim, Seong-Min,Oh, Jung-Tak,Han, Seok-Joo,Choi, Seung-Hoon 대한소아외과학회 2006 소아외과 Vol.12 No.2

Solid pseudopapillary tumor (SPT) of the pancreas occurs most frequently in the second or third decades of life, and is prevalent in females. Unlike other pancreatic malignancy, SPT usually has a low malignancy potential. This study reviews our clinical experience and surgical treatment of pancreatic SPT. Admission records and follow-up data were analyzed retrospectively for the period between January 1996 and January 2003. Five patients with a pancreatic mass were operated upon and SPT was confirmed by pathology in each case. The male to female ratio was 1: 4. The median age was 13.8 years. Findings were vague upper abdominal pain (n=5, 100 %) and an abdominal palpable mass (n=3, 60 %). The median tumor diameter was 6.8cm and the locations were 2 in the pancreatic head (40 %) and 3 in the pancreatic tail (60 %). Extra-pancreatic invasion or distant metastasis was not found at the initial operation in all five cases. A pyloruspreserving pancreaticoduodenectomy (n=1) and a mass enucleation (n=1) were performed in two patients of pancreatic head tumors. For three cases of tumors in pancreatic tail, distal pancreatectomy (n=2) and combined distal pancreatectomy and splenectomy (n=1) were performed. The median follow-up period was 60 months(12-117month). During the follow-up period, there was no local recurrence, nor distant metastasis. Postoperative adjuvant chemotherapy or radiotherapy was not carried out. All five children were alive during the follow up period without any evidence of disease relapse. SPT of the pancreas in childhood has good prognosis and surgical resection of the tumor is usually curative.

소아 급성 충수염의 진단과 치료: 10년간의 변화

김성민,김세훈,최현호,한석주,최승훈,황의호,오정탁,Kim, Seong-Min,Kim, Se-Hoon,Choi, Hyun-Ho,Han, Seok-Joo,Choi, Seung-Hoon,Hwang, Eui-Ho,Oh, Jung-Tak 대한소아외과학회 2007 소아외과 Vol.13 No.1

Appendicitis is the most common surgical emergency in childhood and the technologic advances of modern medicine have affected the diagnosis and treatment of appendicitis. This study is to evaluate the differences in diagnosis and treatment of appendicitis between present and 10 year ago. The authors retrospectively reviewed the medical records of patients who underwent appendectomy under the diagnosis of the acute appendicitis from July 1993 to June 1995 (Group A, n = 78) and from July 2003 to June 2005 (Group B, n = 105). There are no differences between group A and B in mean age ($8.5{\pm}3.6$ vs. $9.3{\pm}3.1$ year), duration of symptoms ($3.0{\pm}3.2$ vs. $2.6{\pm}3.8$ days), and postoperative hospital stay ($6.6{\pm}4.8$ vs. $5.8{\pm}3.6$ days). Preoperative abdominal ultrasonogram and/or computed tomogram was performed in 7 patients (9.0 %) of group A and in 51 patients (58.5 %) of group B. Thirty-six patients (34.3 %) of group B underwent laparoscopic appendectomy, but none in group A. Incidence of a histologically normal appendix decreased from 15.8 % in group A to 4.8 % in group B (p =0.018). This study suggests that utilization of abdominal ultrasonogram or computed tomogram in preoperative evaluation become more popular and surgical treatment of acute appendicitis become more minimally invasive. The rate of negative appendectomy was also reduced compared with 10 year ago.

삼귀용탕가감이 체표온도변화에 미치는 영향

송인선 ( In Sun Song ),김일수 ( Ho Sang You ),유호상 ( Seung Hoon Choi ),최승훈 ( Min Seok Oh ) 한방재활의학과학회 2002 한방재활의학과학회지 Vol.12 No.4

Objectives : Observe Effect of Sanguilongtanggagam on difference of Jungcho skin temparature(JST). Methods : After administration of Sanguilongtanggagam, taking skin temperature between Sangcho and Jungcho using DITI every ten minute for one hour.Results : Average maximum differance of all 15 person is 0.12. This differance is significant. 7 person`s average maximum differance is 0.27 This differance has more significance. Sanguilongtanggagam effect on 7 persons and less effect on 8 persons. In sasang(四象) theory, 6 persons` constitution is soyangin(少陽人). 1 person`s constitution is taeumin(太陰人). Probably Sanguilongtanggagam has very close relation with constitution.

관절1호방이 Collagen Ⅱ로 유발된 관절염 억제에 관한 연구

한규진 ( Kyu Jin Han ),진광선 ( Kwang Seon Jin ),신혜란 ( Hye Ran Shin ),윤일지 ( Il Ji Yoon ),최승훈 ( Seung Hoon Choi ),오민석 ( Min Seok Oh ) 한방재활의학과학회 2005 한방재활의학과학회지 Vol.15 No.4

Objectives : The aim of this study was to know the immunity responses of Gwanjulbang-1(Quanjiefang-1)(hereinafter referred to GJB-1) to on Rheumatoid Arthritis in Collagen-induced Arthritis(CIA) Mice Methods : For this purpose, experiments were performed to measure the cytotoxicity against mLFC, hFLSs and the production of proinflammatory cytokines IL-1β, IL-6, TNF-α, IFN-γ in hFLSs and the production of pro-inflammatory cytokines IL-4, IL-10 and the value of CD3+(T), CD19+(B), CD3+/CD69+, CD4, γδ T cells, CD4+/CD25+ Results : 1. The cytotoxicity against mLFC, hFLSs were not measured. 2. The production of pro-inflammatory cytokines IFN-γ were reduced in hFLSs. 3. The production of pro-inflammatory cytokines IL-4, IL-10 were increased. 4. Statistically significant value of CD3+(T), CD19+(B), CD3+/CD69+, CD4, γδ T cells, CD4+/CD25+ compared with control group, wild type, MTX. Conclusions : Comparison of the results for this study showed that GJB-1 had immunomodulatory effects of suppressing or enhancing. So we expect that GJB-1 should be used as a effective drugs for not only rheumatoid arthritis but also another auto-immune disease. Therefore we have to survey continuously in looking for the effective substance and mechanism in the future.