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      • 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.

      • 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.

      • KCI등재

        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.

      • 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.

      • 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.

      • KCI등재

        조립식 물량저감 중공 철근콘크리트 교각의 성능평가

        김태훈,박동규,이재훈,신현목,Kim, Tae-Hoon,Park, Dong-Kyu,Lee, Jae-Hoon,Shin, Hyun-Mock 한국지진공학회 2016 한국지진공학회논문집 Vol.20 No.1

        This study investigates the performance of hollow precast segmental bridge columns with reinforcement details for material quantity reduction. The proposed triangular reinforcement details are economically feasible and rational, and facilitate shorter construction periods. The precast segmental bridge columns provides an alternative to current cast-in-place systems. We tested a model of hollow precast segmental bridge columns under a constant axial load and a quasi-static, cyclically reversed horizontal load. We used a computer program, Reinforced Concrete Analysis in Higher Evaluation System Technology (RCAHEST), for analysis of reinforced concrete structures. The used numerical method gives a realistic prediction of performance throughout the loading cycles for hollow precast segmental bridge column specimens investigated. As a result, proposed reinforcement details for material quantity reduction was equal to existing reinforcement details in terms of required performance.

      • KCI등재

        태양광 조명 시스템의 집광 효율 향상을 위한 정렬 및 패키징 기술

        김태훈,신병한,정명영,Kim, Taehoon,Sheen, Byung-Han,Jeong, Myung Yung 한국마이크로전자및패키징학회 2014 마이크로전자 및 패키징학회지 Vol.21 No.3

        본고에서는 태양광 조명 시스템 중 태양을 추적하며 오목한 형태의 반사경으로 태양광을 집광하고, 전기에너지로 변환과정 없이 그대로 조명으로 사용하는 시스템의 효율 향상에 관해 다뤘다. 반사경 및 렌즈들의 초점거리, 위치 등에 따라 시스템 전체의 효율이 크게 좌우되고, 제품의 조립 및 제작 과정, 외적 환경요인 등에 의해 렌즈 및 거울간의 정렬 상태가 집광효율에 상당한 영향을 준다. 시뮬레이션을 통해 최대효율을 내기 위한 convex lens의 위치를 확인하였다. In this work, we investigated the efficiency improvement of concave mirror based solar daylighting system that does not convert light to electricity. Total efficiency of the system is substantially affected by external environment and focusing position, alignment of reflectors, lenses. As a result of simulation, we obtained the max. efficiency in which depends on convex lens position.

      • KCI등재

        스타이렌 공중합체의 물리적 특성 및 콘택트 렌즈로의 응용

        김태훈,예기훈,성아영,Kim, Tae-Hun,Ye, Ki-Hun,Sung, A-Young 대한화학회 2009 대한화학회지 Vol.53 No.6

        Styrene은 중합체와 공중합체로 널리 사용되어져 왔으며, 고 굴절률을 가지고 있기 때문에 콘택트렌즈 재료로 유용하게 사용된다. 본 연구는 styrene을 교차결합제인 EGDMA (ethylene glycol dimethacrylate)와 HEMA (2-hydroxyethyl methacrylate) 그리고 개시제인 AIBN (azobisisobutyronitrile)을 사용하여 공중합 하였다. 공중합한 안 의료용 재료의 물리적 특성을 측정한 결과 굴절률 1.4412-1.4628, 함수율 20-35%, 가시광선 투과율 82.6-87.0%, 인장강도 0.143-0.344 Kgf를 나타내었다. Styrene의 비율이 증가할수록 굴절률과 인장강도는 증가하였으며, 함수율은 감소하였다. 본 실험결과로 볼 때 생성된 공중합체는 기능성을 가진 고성능 콘택트렌즈 재료로 사용될 수 있을 것으로 판단된다. Styrene is broadly used as a polymer and a copolymer and is useful in manufacturing contact lenses due to its high refractive index. This study used styrene with the cross-linker EGDMA (ethylene glycol dimethacrylate), HEMA (2-hydroxyethyl methacrylate) and the initiator AIBN (azobisisobutyronitrile) for copolymerization. Measurement of the physical characteristics of the copolymerized material showed that the refractive index is 1.4412 - 1.4628, water content 20 - 35%, visible transmittance 82.6 - 87% and the tensile strength 0.143 - 0.344 Kgf. Also, measurements showed that the refractive index and tensile strength increased while the water content decreased as the ratio of styrene increased. Based on the results of this study, the produced copolymer can be estimated to be suitable for use as a material for high performance functional contact lenses.

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