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.

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

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.

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.

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

생산성 및 비용 분석을 통한 철골 구조체 건설 자동화 시스템의 요구성능 분석

김태훈,이웅균,조훈희,강경인,Kim, Tae-Hoon,Lee, Ung-Kyun,Cho, Hun-Hee,Kang, Kyung-In 대한건축학회 2012 대한건축학회논문집 Vol.28 No.1

Automated building construction systems are currently being employed as an effective alternative for the recent aging of the workforce and the lack of skilled labor. In order to apply such systems effectively in building construction process, the influence on overall construction process by the systems should be examined in the developing phase. Moreover, appropriate performance criteria for the systems should be determined based on the aspect of cost-effectiveness. Therefore, this study analyses performance criteria of an automated building construction system for steel framework by using a simulation technique, CYCLONE, and economic feasibility analysis in order to developing and employing the system efficiently. The study targets the steel girder installation process through a manless steel frame and joint method and bolting robot which is developed by the robot-based construction automation (RCA) group in Korea. The result shows that the manless steel frame and joint method leads substantial productivity improvement for the steel girder installation process by the reduction of loads for resources. In addition, considering productivity and costs of the system on overall process, the maximum permissible capital cost for the bolting robot increases dramatically when a cycle time of the robot ranges from 320 to 440 seconds. The results of this study will help develop cost-efficient system, and serve as a decision support model for appropriate resource inputs of the construction automation method.

공과대학생의 기술적 문제해결 전략과 자아조절 관련 변인과의 상관 연구

김태훈,Kim Tae-Hoon 한국공학교육학회 2005 공학교육연구 Vol.8 No.2

이 연구에서는 공학에서 접하게 되는 문제의 유형인 설계와 고장해결에 있어서 문제해결 전략이 자아 조절 관련 변인들, 즉 계획하기, 자아 관리, 노력, 자아 효능감 등의 변인들이 어떠한 관계를 보이고 있는지 확인하고자 한다. 공과대학 학생 120명을 대상으로 문제해결 전략 검사와 자아 조절 성향 질문지를 실시하였다. 검사 결과를 이용하여 설계 및 고장해결 전략과 자아 조절 변인간의 상관 관계를 분석하고 설계 전략과 고장 해결 전략의 상, 하위 집단간 자아 조절 관련 변인들의 집단간 평균 비교를 실시한 결과를 바탕으로 다음과 같은 결론을 도출하였다. 고장해결 문제에 대한 타당한 전략의 수는 자아 효능감과 계획하기와 정적 상관이 있으며, 설계 문제에 대한 타당한 전략의 수는 자아 관리, 계획하기, 노력과 정적 상관이 있는 것으로 확인되었다. 또한 자아 효능감만이 문제해결에 있어서 타당한 전략의 수와 직접적인 관계가 있는 것으로 나타났다. The purpose of this study is to investigate the correlations between technological problem solving strategies and variables related with self-regulation of students in engineering college. The subjects for this study are 120 students from engineering college. After using the problem solving strategy task and self-regulation questionnaire, they were classified into two groups, upper 25% group and bottom 25% group. The data was analyzed using the SPSS 10.0 for windows. The statistical technique used for data analysis was Pearson's correlation coefficient and t-test. The major conclusions of this study are as follows. Frist, there is positive correlation between strategies of design and self-efficacy & planning. Second, there is positive correlation between strategies of trouble shooting and self-monitoring, planning and effort. Third, especially self-efficacy, one of the self-regulation subvariables, directly affects on technological problem solving strategies.

치과용 레진 시멘트의 중합 수축률 특성에 관한 연구

김태훈,양재호,이재봉,한중석,김성훈,Kim, Tae-Hoon,Yang, Jae-Ho,Lee, Jai-Bong,Han, Jung-Suk,Kim, Sung-Hun 대한치과보철학회 2010 대한치과보철학회지 Vol.48 No.1

연구 목적: 치과용 레진시멘트의 중합 수축은 수복물이 치아에 정확하게 합착되는 것을 방해하고, 내부 응력의 원인이 되어 치아에 여러 문제점을 일으킬 수 있다. 이러한 임상적인 문제점을 줄이기 위해서 사용하는 치과용 레진시멘트의 중합 수축률에 대해 아는 것이 중요하다. 본 연구에서는 상업적으로 이용되고 있는 몇 가지 레진시멘트의 시간에 따른 중합 수축률을 측정, 서로 비교하고자 하였다. 연구 재료 및 방법: 3종류의 자가 중합형 레진시멘트(Fujicem, Superbond, M bond)와 3종류의 이원 중합형 레진시멘트(Maxcem, Panavia F, Variolink II) 별로 각각 5개의 시편을 이용하였다. 각 재료의 중합 수축률은 Bonded disk method를 이용하여 측정하였다. 안쪽 직경 16 mm, 두께 1 mm 의 동으로 제작된 링을 유리판 ($74\;mm\;{\times}\;25\;mm\;{\times}\;3\;mm$) 위의 중앙에 위치시켜 부착하고, 그 유리판 중앙에 실험 재료를 구 형태로 만들어 올리고, 다른 유리판으로 눌러서 원판 형태 (직경 8 mm, 두께 1 mm)의 시편을 제작하였다. 시편의 중합 수축률은 재료가 중합이 시작된 후 120분동안, $23^{\circ}C$에서 측정하였다. 시간에 따른 수축량에 대한 kinetics curve를얻고, 각 실험 재료의 수축률의 평균값 (%)과 표준편차를 구한 뒤, one-way ANOVA 및 Scheffe post hoc test를 유의수준 0.05 에서 처리하여 그 결과 값을 비교하였다. 결과: 1. 실험에 사용된 Fujicem, Maxcem, M bond, Panavia F, Superbond, Variolink II 은 중합이 시작 된 120 분 후의 중합 수축률이 각각 3.72%, 4.19%, 4.13%, 2.44%, 7.57%, 2.90%의 값을 보였다. 2. Panavia F가 중합 수축률이 가장 작았고, Superbond가 중합 수축률이 가장 컸다 (P<.05). 3. Maxcem 과 M Bond 간에는 유의한 차이가 없었다 (P>.05). 4. 6종류의 레진 시멘트에서 90% 이상의 대부분의 수축은 중합이 개시된 30분 내에 거의 일어났다. 결론: 자가 중합형 레진시멘트의 혼합 후 나타나는 중합 수축이 이원 중합형 레진시멘트보다 천천히 일어나지만, 혼합 120분 뒤의 중합 수축은 이원 중합형 레진 시멘트 보다 유의할 정도로 높았다. 치과용 레진시멘트의 중합 수축은 혼합한 후 30 분내에 대부분 일어난다. Purpose: The shrinkage of dental resin cement may cause several clinical problems such as distortion that may jeopardize the accurate fit to the prepared tooth and internal stress within the restorations. It is important to know the polymerization shrinkage-strain of dental resin cement to reduce clinical complications. The purpose of this study was to investigate the polymerization shrinkage-strain kinetics of six commercially available dental resin cements. Material and methods: Three self-cure resin cements (Fujicem, Superbond, M-bond) and three dual-cure resin cements (Maxcem, Panavia-F, Variolink II) were investigated. Time dependent polymerization shrinkage-strain kinetics of the materials were measured by the Bonded-disk method as a function of time at $23^{\circ}C$, with values particularly noted at 1, 5, 10, 30, 60, 120 min after mixing. Five recordings were taken for each materials. The data were analyzed with one-way ANOVA and Scheffe post hoc test at the significance level of 0.05. Results: Polymerization shrinkage-strain values were 3.72%, 4.19%, 4.13%, 2.44%, 7.57%, 2.90% for Fujicem, Maxcem, M bond, Panavia F, Superbond, Variolink II, respectively at 120 minutes after the start of mixing. Panavia F exhibited maximum polymerization shrinkage-strain values, but Superbond showed minimum polymerization shrinkage-strain values among the investigated materials (P < .05). There was no significant differences of shrinkage-strain value between Maxcem and M bond at 120 minutes after the start of mixing (P > .05). Most shrinkage of the resin cement materials investigated occurred in the first 30 minutes after the start of mixing. Conclusion: The onset of polymerization shrinkage of self-cure resin cements was slower than that of dual-cure resin cements after mixing, but the net shrinkage strain values of self-cure resin cements was higher than that of dual-cure resin cements at 120 minutes after mixing. Most shrinkage of the dental resin cements occurred in the first 30 minutes after mixing.