소아의 만성 반복성복통의 진단과 치료

정기섭,Chung, Ki-Sup 대한소아소화기영양학회 1998 Pediatric gastroenterology, hepatology & nutrition Vol.1 No.1

소아의 만성 변비

정기섭,Chung, Ki Sup 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.suppl1

Chronic functional constipation is a common problem in childhood, with soiling a significant issue. It presents a management problem for pediatrician, and parental concern is high. About 5% of pediatric patients is known to have constipation and/or encopresis which is the second most referred disease in pediatric gastroenterology clinic, accounting for up to 25% of all visits. The etiology of constipation was based on initiation factors including vicious cycle concept, genetic factors, psychological factors, dietary influences and histologic abnormalities of colon. Emphasis is placed on the evaluation and management options that are available to the treating pediatrician. Careful history taking is most important to diagnose functional constipation. In addition, diagnostic tests such as plain abdominal radiograph, colonic transit study, anorectal manometry, barium enema were helpful to diagnose the constipation. Childhood constipation can be very delicate to treat. It often requires prolonged supports by physicians and parents, demystification, medical treatment and especially with the child and parent's cooperation.

영아기에 있어서 B 형 간염 백신의 접종 방법과 면역 효과

정기섭(Ki Sup Chung),김난애(Nan Ae Kim) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.3

N/A Hepavax has been evaluated for immunogenicity in 36 infants who were negative for hepatitis B markers including HBsAg, anti-HBc, anti-HBs, HBeAg and anti-Hbe, and had normal serum SGOT and SGPT levels. Three doses of Hepavax 0.5 ml (HBsAg, 10 pgm) was administered intramuscularly in the deltoid muscle at 0,1 and 2 months, and then sera were collected from the subjects at monthly intervals for 3 months after the first injection. All sera were tested for HBsAg, anti-HBc, and anti-HBs by radioimmunoassay. The results were as follows: 1) The anti-HBs response to Hepavax in 36 infants was 41.7% at 1 month after the first vaccination, 66.6% at 2 months, and 97.2% at 3 months, 2) The geometric mean titer for anti-HBs was 5.1 RU at 1 month after the first injection, 11.3 RU at 2 months, and 48.4 RU at 3 months.. In conclusion, these results suggest that either of the 3 dose schedules, administered at 0,1 and 2 months or 0,1 and 6 months, can achieve excellent anti-HRs response to Hepavax@ in infants.

위장관 ( 胃腸管 ) : 소화기계의 선천성 기형에 대한 임상통계적 관찰 - 최근의 변화 양상 -

정기섭(Ki Sup Chung),한부현(Boo Hyun Han),김문규(Moon Kyu Kim) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3

N/A A clinicostatistical review was done on 505 infants and children diagnosed and treated at the Department of Pediatrics and Surgery in Severance Hospital for congenital digestive tract anomalies from January, 1979 to December, 1988. The results are summarized as follows; 1) There was 505 cases admitted with congenital digestive tract anomalies occupying 1.61% of all pediatric patients admitted during the period from 1979 to 1988. This was a double-fold increaae in the number of patients as compared to the previous 250 cases. The male to female ratio was 1.8:1 which was similar to the ratio of 2.0:1 between 1966 and 1975. 2) The most common congenital anomaly was congenital hypertrophic pyloric stenosis with 122 cases (24.2%), followed by imperforate anus with 106 cases (21.0%), congenital megacolon with 104 cases (20.6%) and congenital hepatobiliary anomalies with 51 cases (10.1%). In the report of 1966~75, congenital megacolon was the most frequent anomaly followed by imperforate anus and congenital hypertrophic pyloric stenosis. There were also 14 cases of midgut malrotation and 5 cases of gastroschisis which were not present in the previous report. On the otber hand, the number of cases with Meckel's diverticulum had decreased (8 cases) since the previous report (18 cases). 3) Among 37 cases of congenital anomalies of small and large intestine, 19 cases (51.4%) were ileal atresia followed by 7 cases (18.9%) of duodenal atresia. 4) Associated anomalies were observed in 66.0% to 85.7% of cases with situs inversus, imperforate anus and gastroschisia However, the overall incidence of congenital malformations was 25.0% which was not significantly different from that of the previous study (22.8%). When the incidence of associated anomalies were analyzed with the previous report, it was noted that there was a rise in the incidences of associated anomalies in imperforate anus from 17.8% to 66.0% and in congenital hepatobiliary anomalies from 12.0% to 21.6% while a fall in incidences was noted in congenital megacolon from 12.0% to 4.8%, in congenital hypertrophic pyloric stenosis from 9.7% to 4.1%, in congenital intestinal anomalies from 41.4% to 5.9% and in situs inversus from 100% to 85.% 5) Surgery was done in 419 cases. Among them 26 cases (6.2%) expired which was a significant decrease in mortality rate as compared to previous report (19.3%). When the mortality rate of each disease was compared to that of the previous report, the mortality rate of imperforate anus decreased from 14.3% to 1.0%, that of congenital megacolon from 15.6% to 2.5%, congenital hepatobiliary anomalies from 47.6% to 5.3% and congenital intestinal anomalies from 40.7% to 18.8%. 6) The most common contributing factor to death was respiratory failure (73.0%) as in the previous study. Sepsis was also a common contributing factor to death.

영아 및 소아의 설사질환

정기섭(Ki Sup Chung),이현수(Hyeon Soo Lee) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.1

N/A This study was undertaken to investigate the incidence, cases, clinical features, antimicrobial sensitivity to causative organisms, and prognosis of 1300 patients with diarrheal disease who had been admitted to the Department of Pediatrics, Yonsei University of College of Medicine during a 3 year period from January, 1984 to December, 1986. Of the 9897 patients admitted during the 3 year period of this investigation, 1300 patients(13.1%) had diarrheal diseases, and the annual incidence of diarrheal disease showed a slightly increased occurrence rate from 9.9% in 1984 to 16.6% in 1986. Among the 1300 diarrheal patients, acute diarrhea accounted for 95.4% of the cases and chronic diarrhea accounted for 4.6%. The causes of acute diarrhea included acute bacterial gastroenteritis in 10.6% of the cases, acute human rotaviral(HRV) gastroenteritis in 43.4%, parenteral diarrhea in 15. 2% and cause undetermined gastroenteritis in 30.1%. Of 131 patients with bacterial gastroenteritis, 40. 5% were attributed to Shigella, 24.4% to Salmonella, 32.8% to enteropathogenic E.cole and 2.3% to Campylobacter jejuni. With regard to the causes of diarrhea, bacterial gastroenteritis occurred most commonly among preschoolers(41.2%) but HRV gastroenteritis occurred during infancy(65.2%). Seasonal incidence showed that bacterial gastroenteritis occurred most commonly in summer(36.6%) and HRV gastroenteritis in winter(47.4%). Hypotonic dehydration was observed in 13.0% of the patients with bacterial gastroenteritis and in 7.4% with HRV gastroenteritis. 31.1% of the patients with bacterial infection and 50.7% with HRV infection has a low serum CO2 level of less than 15 mEq/L. Shigella was most sensitive to amikin in 91% of the cases, but resistant to ampicillin in 97%. Enteropathogenic E. coli was most sensitivee to amikin in 77% and gentamycin in 69%. Salmonella was most sensitive to amikacin and tobramycin in 100%. Of the 1300 patients, almost all of them (99.5%) improved with medical treatment; 3 cases (0.2%) developed chronic diarrhea; and 2 cases (0.2%) expired.

간장 및 담도 : 소아의 만성 B형 간염에 대한 Prednisolone 및 Adenine Arabinoside 병용 요법의 치료 효과

정기섭(Ki Sup Chung),김문아(Moon A Kim) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.1

N/A The therapeutic effect of prednisolone withdrawal followed by adenine arabinoside was evaluated on 39 cases with chronic hepatitis B who had been admitted to the Department of Pediatrics, Yonsei University College of Medicine from January 1984 to January 1989. Of 39 patients, 26 cases were randomized into a treatment group, and 13 cases into a control group. The duration of follow-up was 21 +- 12 months.The results were as follows: 1) The mean age of the 39 children was 8.5 +- 3.8 years, and 31 cases were male and 8 cases were female. Pathologically, 23 cases had chronic persistent hepatitis (CPH), 8 cases had chronic active hepatitis (CAH), and 8 cases had chronic lobu]ar hepatitis (CLH). There was no significant difference in the clinical characteristics between the treatment and control group. 2) The serum levels of AST and ALT were normalized in 19 of 26 cases (73%) in the treatment group, and 8 of 13 cases (62%) in the control group. HBeAg was cleared in 19 (73%) of the treated patients, and in 3 (23%) of the control patients, which indicates a statistically significant (p<0.01) higher clearance rate of HBeAg in the treatment group. Anti-HBe became seropositive in 15 (58%) of the treated patients, and in 2 (15%) of the control patients, which indicates a statistically significant (p<0.025)higher seropositive rate of anti-HBe in the treatinent group as bell. 3) The normalization rate of serum AST and ALT, the clearance rate of HBeAg and the seropositive rate of anti-HBe after treatment were 69%, 69%, 63% in CPH, 71%, 71%, 57% in CAH, and 100%, 100%, 33% in CLH respectively. 4) After treatment with prednisolone and ARA-A, normalization of serum AST and ALT took 5.5 +- 6.1 months, clearance of HBeAg 7.4 +- 4.8 months, and positive conversion of anti-HBe 12.8 +- 8.8 months. 5) With regard to the relationship between the pretreatment peak serum level of ALT and the clearance rate of HBeAg in the treatment group, 2 of 7 patients (29%) with an ALT level less than 100 IU/L lost HBeAg, but 17 of 19 patients (90%) with an ALT level greater than 100 IU/L lost HBeAg, which means there was a statistically significant (p<0.05) higher clearance rate of HBeAg in the last group. 6) With regard to the relationship between the post-treatment peak serum level of ALT and the clearance rate of HBeAg in the treatment group, 2 of 3 patients (67) with an ALT level less than 100 IU/L lost HBeAg, 4 of 8 patients (50%) with an ALT level of 100-199 IU/L lost HBeAg, 4 of 5 patients (80%) with an ALT level of 200~299 IU/L lost HBeAg, and 9 of 10 patients (90%) with an ALT level greater than 300 IU/L lost HBeAg. These findings indicate that the higher the ALT level increases above 200 IU/L, the greater the clearance rate of HBeAg increases. 7) In the control group, none of 3 patients with an ALT level less than 100 IU/L lost HBeAg, 1 of 6 patients (17%) with an ALT level of 100~199 IU/L lost HBeAg, and 2 of 4 patients (50%) with an ALT level greater than 200 IU/L lost H BeAg. Both of the 2 patients who lost H BeAg in the last group had high ALT levels of 608 and 890 IU/L respectively. In conclusion, these results suggest that the combined therapy of prednisolone withdrawal followed by adenine arabinoside can induce an increased clearance rate of HBeAg in children with chronic type B hepatitis.

소화기 증상이 있는 환아의 대변표현형, Bristol 대변형태척도 및 대장통과시간검사와의 상관관계

이용주,정기섭,Lee, Yong Ju,Chung, Ki Sup 대한소아소화기영양학회 2005 Pediatric gastroenterology, hepatology & nutrition Vol.8 No.2

목 적: Bristol 대변형태척도는 대장통과시간을 예측하는 간단한 방법이나 임상적으로 또는 연구목적으로 널리 사용되지 않고 있다. 이에 저자들은 소화기 증상으로 내원한 환아의 대변표현형, Bristol 대변형태척도와 대장통과시간검사 결과를 비교 분석하여 이들 상호간의 연관성 및 Bristol 대변형 태척도의 임상적 유용성을 알아보고자 하였다. 방 법: 2002년 5월부터 2004년 5월까지 소화기 증상으로 연세의대 세브란스 병원 소아과에 내원한 489명의 환아를 대상으로 연령, 성별, 대변의 표현형, Bristol 대변형태를 기술하고, 방사선 불투과성 표지자(Sitzmark$^R$ 또는 Kolomark$^{TM}$) 24개 또는 20개를 연속적으로 3일간 복용시킨 후 4일째 복부 방사선 사진을 촬영하여 대장통과시간을 측정하여 비교 분석하였다. 결 과: 내원한 환아의 평균 연령은 $8.2{\pm}3.9$세로 5세 이하 116명, 5세 초과부터 10세 이하 202명, 10세 초과 171명이었다. 대변표현형은 묽은 변 65명(13.3%), 정상 변 221명(45.2%), 굳은 변 188명(38.4%), 묽은 변과 굳은 변이 교대하는 환아가 15명(3.1%)이었고, Bristol 대변형태는 type 1이 57명(11.7%), type 2가 66명(13.5%), type 3이 203명(41.5%), type 4가 108명(22.1%), type 5가 36명(7.4%), type 6이 18명(3.7%), type 7이 1명(0.2%)이었다. 환아의 평균대장통과시간은 $35.9{\pm}19.5$시간이었다. 연령군과 평균 대장통과시간은 상관관계(p=4)가 없었다. 환아의 대변표현형, Bristol 대변형태, 대장통과시간은 통계학적으로 유의한 상관관계(p<0.001)를 보였으며, 환아가 진술한 대변표현형과 Bristol 형태는 유의한 상관관계(p<0.01)를 가지고 있었으나, 일치율은 묽은 변 29%, 정상 변 37%, 굳은 변 87%로 대변표현형이 굳은 변으로 감에 따라 높았고, 묽은 변으로 갈수록 일치율은 현저히 낮았다. 결 론: 대장통과시간 검사를 시행하지 못하는 환아에 있어서 Bristol 대변형태척도를 이용하여 대장통과시간을 예측하는 것이 임상 진료에 도움이 될 것으로 생각된다. Purpose: The aim of this study was to evaluate the correlation among descriptions regarding one's stool, Bristol stool form scale and colon transit time (CTT) in children with gastrointestinal symptoms, along with the clinical significance of Bristol stool form scale. Methods: 489 patients treated in the pediatric department of Severance hospital with gastrointestinal symptoms between May 2002 to May 2004 were included. We analyzed their age, sex, verbal descriptions of stool, Bristol stool form types, and CTT measured by Metcalf's method. Results: 116 children were under 5 years of age, 202 children between 5.1~10, and 171 children 10 years of age or older. Their mean age was $8.2{\pm}3.9years$. Stools were described as loose in 65 children (13.3%), normal in 221 (45.2%), hard in 188 (38.4%), and mixed (loose+hard) in 15 (3.1%). According to Bristol stool form scale, 57 children(11.7%) were classified as type 1, 66 (13.5%) as type 2, 203 (41.5%) as type 3, 109 (22.3%) as type 4, 36 (7.4%) as type 5, 18 (3.7%) as type 6, and 1 (0.2%) as type 7. Their mean CTT was checked $35.9{\pm}19.5hours$. Though no significant relationship was observed between age and CTT (p=0.4), a significant relationship was noted among patient's stool description, Bristol stool form scale and CTT (p<0.001). However, concordance between stool description and Bristol stool form was relatively low in the loose stool group (29%) and normal stool group (37%) while high in the hard stool group (87%). Conclusion: Bristol stool form scale could be used in the estimation of CTT in clinical practice.

농촌 및 도시 지역 어린이의 머릿니 감염 실태

배기수(Ki-Soo Pai),배민수(Min-Soo Park),이일섭(Yil-Sup Lee),김덕희(Duk-Hi Kim),정기섭(Ki-Sub Chung),이기영(Ki-Young Lee),김병길(Pyung-Kil Kim),김길영(Kir-Young Kim),용태순(Tai-Soon Yong),이한일(Han-Il Ree),임경일(Kyung-Il Im),허선(Sun 대한기생충학열대의학회 1989 The Korean Journal of Parasitology Vol.27 No.4

1996년도 제35차 대한소화기학회 추계학술대회 / 포스터 발표 : 위장관 ; 만성재발성복통 환아의 대장통과시간에 대한 연구

김제우,정기섭 ( Je Woo Kim,Ki Sup Chung ) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

1996년도 제35차 대한소화기학회 추계학술대회 / 일반연제 : 위장관 ; 소아에서 내시경 검사로 진단된 위장관 질환과 Helicobacter pylori 감염 유무에 따른 혈청 Pepsinogen Ⅰ , Ⅱ 치에 대한 연구

김제우,정기섭 ( Je Woo Kim,Ki Sup Chung ) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1