소아에서 둔상 후에 발생한 담도협착의 내시경적 치료 경험 1례

김경모,김성철,서동완,윤종현,Kim, Kyung-Mo,Kim, Seong-Chul,Seo, Dong-Wan,Yoon, Chong-Hyun 대한소아소화기영양학회 1998 Pediatric gastroenterology, hepatology & nutrition Vol.1 No.1

저자들은 복부 둔상 후에 발생한 담도 단독 협착을 보인 환아에서 수술적인 치료를 대신하여 내시경적 경비담도 배액술과 플라스틱 스텐트 삽입으로 증상의 호전과 2년의 추적관찰에서 재발을 보이지 않고 있는 1례를 경험하여 문헌고찰과 함께 보고하는 바이다. Isolated injury to the extrahepatic biliary tract following blunt abdominal trauma is rare, and there is little information especially in children regarding the endoscopic diagnosis and management of occult injury to the biliary tract. We experienced a 5-year-old boy who presented with jaundice 16 days after blunt abdominal trauma and was diagnosed as isolated distal common bile duct stricture by ultrasonography of abdomen. We could get more detailed information about the injury by endoscopic retrograde cholangiopancreatography. We could also manage this isolated common bile duct stricture successfully with endoscopic nasobiliary drainage and plastic stent insertion instead of surgical correction. There appeared to be no recurrence of stricture as evidenced by biochemical test and ultrasonography during 2 years of follow up.

소아에서 간기능 검사 이상 소견의 해석과 실제

김경모,Kim, Kyung Mo 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.suppl1

The causes of liver disease in children and abnormal liver function test are more diverse than those in adult. Therefore, the first step to evaluate the liver disease is the understanding the liver disease and interpreting the appropriate liver function test in children. The characteristics of each test and various conditions which we encounter in outpatients settings will be discussed in this article, especially focused on elevation of aminotransferase level without identifiable causes.

소아 간이식

김경모,Kim, Kyung Mo 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.8

소아청소년 염증성 장질환의 치료

김경모,Kim, Kyung Mo 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.suppl2

The incidence of inflammatory bowel disease is increasing rapidly in Korea and one quarter of the new patients present in childhood. Crohn's disease and ulcerative colitis are incurable conditions associated with significant morbidity, therefore the focus of treatment in children should be to reduce or eliminate symptoms, optimize nutritional status and growth, prevent complications. This review will deal with the evidence supporting the treatments currently used in children with inflammatory bowel disease.

신생아 담즙정체증의 원인질환 및 장기추적 예후인자에 관한 고찰

김경모,서정기,Kim, Kyung-Mo,Seo, Jeong-Kee 대한소아소화기영양학회 1999 Pediatric gastroenterology, hepatology & nutrition Vol.2 No.1

목 적: 신생아 담즙정체증은 소아과 소화기 영역에서 중요한 질환의 하나임에도 불구하고 원인 질환 및 장기추적 고찰에 대한 국내의 보고가 드문 실정이다. 따라서 저자들은 신생아 담즙정체증의 원인 및 추적조사시의 합병증 등의 임상적 고찰과 함께 예후인자를 분석하여 신생아 담즙정체증 환아의 진료에 도움을 주고자 본 연구를 시행하였다. 방 법: 1981년부터 1992년까지 12년간 신생아 혹은 초기 영아기에 발생한 담즙정체증으로 서울대학교 어린이병원 소아과에 입원하였던 190명을 대상으로 하였다. 담즙정체증의 원인질환, 추적조사시에 관찰된 합병증 및 사인, 특발성신생아간염과 담도폐쇄증의 초기의 임상적 차이점, 예후 및 예후 인자를 분석하였다. 결 과: 1) 담즙정체증의 원인질환은 190명에서 신생아 간염이 101례(53%), 간외담도계 질환이 84례(44%), 간내담도형성부전증이 5례(3%)이었다. 신생아간염은 특발성신생아간염이 77례(41%), 감염성 신생아 간염이 24례(12%)이었고, 간외담도질환은 담도폐쇄증이 79례(41%), 총수담관낭이 5례(3%)이었다. 2) 추적조사시에 관찰된 주요한 임상적 문제점은 지속적인 고열, 위장관출혈, 간성혼수, 복수 등이었다. 3) 담도폐쇄증 환아에서 지속적인 고열의 원인은 상행성담관염, 혹은 line-related sepsis가 58%이었고, 폐렴이 15%, 요로감염이 8%, 상기도 감염이 7%이었다. 4) 상행성담관염 혹은 line related sepsis의 원인균은 Escherichia coli가 28%로 가장 빈도가 많았고, Coagulase negative staphylococcus가 14%, Streptococcus pneumoniae, Klebsiela pneumoniae가 각각 10%, Enterococcus가 6%, Candida albicans가 4%이었다. 5) 주요한 사인은 간성혼수와 위장관출혈이었다. 6) 특발성신생아간염은 71%, 감염성 신생아간염은 75%의 환아에서 회복되었으며, 대부분 생후 12개월 이내, 주로 6개월 이내에 회복되었다. 미숙아, 초기의 간종대가 작은 경우, 초기 알부민치 높은 경우, 콜레스테롤치, ${\gamma}$-GT치, 빌리루빈치 및 AST치가 낮은 경우에서 예후가 양호하였다. 7) 담도폐쇄증 환아의 Kasai수술후의 5년 생존율은 40%이었고 사망의 대부분은 12개월 이내에 관찰되었다. 가장 중요한 예후인자는 수술시기이었고 수술시기가 12주 이전인 49%가 양호한 예후를 보인 반면에, 12주 이후인 경우는 12%이었다. 8) 담즙정체증의 초기 임상소견중 가장 중요한 예후인자는 원인질환이었다. 9) 특발성신생아간염과 담도폐쇄증 사이에서 차이를 보인 임상소견은 성별, 제태연령, 콜레스테롤 치 및 ${\gamma}$-GT치 이었다. 특발성신생아간염은 남아, 미숙아에서 호발하였고, 낮은 콜레스테롤치 및 ${\gamma}$-GT치를 보였다. 결 론: 우리나라에서 신생아 담즙정체증의 흔한 원인으로는 담도폐쇄증과 특발성신생아간염의 빈도가 가장 높았고, 이외에 감염성 신생아 간염, 총수담관낭, Alagille 증후군 등이었으며, 유전성, 대사성질환은 관찰되지 않았다. 신생아 담즙정체증에서 원인질환은 예후를 결정하는 가장 중요한 요인으로 원인질환에 대한 적절한 진단이 요구되며, 또한 상행성 담관염, 폐렴, 패혈증 등의 감염문제, 간성혼수, 위장관 출혈 등은 장기 추적시의 자주 발생하는 심각한 임상적 문제점으로서 이에 대한 적절한 치료대책이 요구된다고 하겠다. Purpose: The aim of the present study was to evaluate the long-term clinical profile including the underlying etioligy and the prognostic factors of the neonatal cholestasis. Method: We studied the 190 infants presented with neonatal cholestasis for the last 12 years (from 1981 to 1992). The underlying causes, clinical findings and long-term outcomes were evaluated. And the prognostic factors were also analyzed. Result: Underlying disease were neonatal hepatitis in 101 (idiopathic in 77 and infectious in 24), intrahepatic bile duct paucity in 5, biliary atresia in 79, choledochal cyst in 5. Metabolic disease was not observed in this study. The important clinical problems during follow-up were persistent high fever, gastrointestinal bleeding, hepatic encephalopathy and ascites. The main causes of the death were hepatic encephalopathy and gastrointestinal bleeding. While three fourth of infants with idiopathic and infectious neonatal hepatitis recovered usually within a year, five-year survival rate for biliary atresia was just 40%, the mortality observed usually within the first year after Kasai operation and prognostic factor was the time of operation. Underlying disease was the most important prognostic factor of neonatal cholestasis. Conclusion: This study showed that most common causes of neonatal cholestasis were biliary atresia and idiopathic neonatal hepatitis, infectious neonatal hepatitis, choledochal cyst and Alagille syndrome, but few neonatal cholestasis of genetic or metabolic liver disease was observed. The most important long-term prognostic factor of neonatal cholestasis was the underlying disease.

소아 간이식의 현재

김경모,Kim, Kyung-Mo 대한소아소화기영양학회 2007 Pediatric gastroenterology, hepatology & nutrition Vol.10 No.1

Outcome of liver transplantation for children with end liver disease has been improved markedly during last two decades. Improvement of immunosuppressive agent and its strategy to use in children, development of innovative surgical technique, and better understanding of the course of liver transplantation attributed to better outcome of pediatric liver transplantation. Therefore this review article will focus on the problems which can occur during pre- and post-transplantation period, current strategy to use immunosuppressive agent for the better understanding of pediatrician who is not involved in transplantation but takes care of the children pre- and postoperatively.

문제 중심의 통합 지향적 일반사회 지역화 교육 과정의 구성에 관한 연구 -경상남도 지역을 중심으로-

김경모 ( Kyung Mo Kim ),김영석 ( Young Seok Kim ),황상주 ( Sang Joo Hwang ) 한국사회과교육학회 2004 시민교육연구 Vol.36 No.2

일본의 학교경제교육개혁 연구 -2005년의 두 회의와 학습지도요령의 개정을 중심으로-

김경모 ( Kyung Mo Kim ),권오현 ( Oh Hyun Kwon ) 한국경제교육학회 2011 경제교육연구 Vol.18 No.2

In this study the interaction between the two gatherings on economic education which took place in Japan at the year of 2005 and the revision of Japanese national curriculum form the year of 2007 was analysed with the relative documents. There is a pervasive academic argument that Japanese method in organizing the contents for economic education by the precollege school has beeen affected by the perspectives of Marxian economics. In the atmosphere like this two gatherings (a gatherings on the status quo and alternatives for Japanese economic education and Economic Education Summit in Japan) on economic education was considered to be very importatnt initiating chance for reforming he existing the Japanese economic education in precollege school. And the degree of revison of economic contents in new Japanese national curriculum was one of main results of the reformative initiatives of two gatherings in 2005. By the analysis of contents of economic education in new national curriculum two gatherings in 2005 affected considerably in the initial stage of the revision of curriculum by ``answer paper(答申)``. But we cannot find the impact on the national curriculum in itself except some point which was trying include some basic economic concepts ane new topics (for example, scarcity, opportunity and financial education)

일본 중등학교 사회과계 학습지도요령의 경제 교육 관련 내용 분석

김경모 ( Kyung Mo Kim ),권오현 ( Oh Hyun Kwon ) 한국경제교육학회 2007 경제교육연구 Vol.14 No.2

통일 이후의 시민성 교육을 위한 시론

김경모(Kyung Mo Kim),홍영환(Young Hwan Hong) 한국사회과교육학회 2002 시민교육연구 Vol.34 No.1

The purpose of this study is divided into two themes. First theme is to reconstruct the concept of citizenship for enhancing the sense of integrity between South and North Korean people after unification. Second one is to develop the introductory curriculum and instructional method guide for the new concept of citizenship. For the first theme I analyzed the thesis of three exemplary authors and for the second theme I analyzed the three case of 1916 model of U.S.A., the initiative curriculum(gyosu yomok) of South Korea and the political education of unified Germany. The suggestion of this study is as follows. ① In reconstructing the concept of new citizenship for unification, the category of knowledge, skill and value & attitude can be still valid as the basic objective area. ② In relation to objcetives of social studies, we must stress the objective of making identity and making the citizen of unified Korea. ③ For this strategy, social science education and reflective inquiry can be stressed in the long run. On the contrary the adaption-oriented social education focussing the affirmative area and problem of usual life can be more useful in short run. ④ In organizing the curriculum the area of history and geography can be stressed around the problem of usual life in short run. So we need re-examining the implication of core curriculum. ⑤ As far as the instructional method concerned, the method and methodology of value education can be reinvestigated around the conflict-ladened problem and immersion of basic value of unified Korea.