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.

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.

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.

보건계열 대학생의 학습전략과 학업 성취도 연구

김태훈,윤태형,김요섭,Kim, Tae-Hoon,Yoon, Tae-Hyung,Kim, Yoseob 대한지역사회작업치료학회 2011 대한지역사회작업치료학회지 Vol.1 No.1

목적: 학습전략과 학업성취도 사이에 상관이 있는지와, 높은 학업성취 대학생과 낮은 학업성취 대학생의 학습전략에 차이가 있는지를 조사해 보고자 하였다. 연구방법: K대학교 보건계열 1학년 대학생 103명을 대상으로 Multi-dimensional Learning Strategy Test를 활용하여 45분 동안 183문항을 조사하였다. 결과: 성격적 특성 중 효능감과 실천력이 학업성취도와 의미 있는 상관이 있는 것으로 드러났으며, 동기적 특성과의 관계에서는 학업성취도가 학습동기와는 유의한 정적인 상관을 보였으나, 회피동기와는 부적 상관을 보여 주었다. 학업성취도와 행동적 특성과의 관계에서는 8개요인 모두에서 통계적으로 유의한 상관을 보여주었다. 높은 학업 성취군과 낮은 학업성취군 사이의 학습전략 사용에 차이가 있는지에 대한 조사 결과를 보면, 성격적 특성에서는 두 그룹사이에 효능감과 실천력에서 유의한 차이가 있었으며, 정서적 특성에서는 낮은 학업성취군 학생들이 우울을 느끼는 정도가 높은 학업성취군 학생들보다 더 큰 것으로 나타났다. 동기적 특성에서는 낮은 학업성취군 학생들은 높은 학업성취군 학생들에 비해 현저히 낮은 학습동기를 가지고 있었으며, 회피 동기에서는 반대로 현저히 높은 것으로 나타났다. 마지막으로, 행동적 특성의 사용능력에 있어서는 8개요인 모두에서 낮은 학업성취군 학생들이 높은 학업성취군 학생들에 비해 현저히 뒤떨어지는 것으로 나타났다. 결론: 학업에서 상대적으로 낮은 성취를 보이는 학생들의 주요한 원인 가운데 하나는 이들이 높은 학업 성취를 보이는 학생들에 비해 학습전략의 사용 능력에 있어서 뒤떨어진다는 사실을 확인하였다. 이러한 점은 대학 교육과정에서 교양이나 전공과목의 개설 뿐 아니라 학습전략의 효과적 사용을 위한 특강이나 세미나 등의 프로그램을 설치 운영할 필요가 있음을 시사한다. This study investigated the relationship between learning strategies and achievements of the students in the department of health science, and differences between higher academic achievers and lower academic achievers in the use of the learning strategies. The results were as follows. First, there was a correlation between academic achievements and self-efficacy and power of execution in the personality area. Second, there was a positive correlation between academic achievements and academic motivation, a negative correlation between academic achievements and avoidnat motivation, in the motivation area. Third. there was a correlation between academic achievements and all 8 factors in the behavior area. In the use of learning strategies, there was a difference found in self-efficacy and the power of execution between the higher academic achievers and the lower academic achievers. It also was found that the lower academic achievers perceived more depression, showed remarkably lower motivation and higher avoidance motivation, than the higher academic achievers. Lastly, the lower academic achievers was lagged behind noticeably compared to the higher academic achievers in the ability of using all factors of the behavior area.

S4 방법을 이용한 선대칭 원주형 계에서의 복사열전달의 해석

김태훈,박흥목 ( Tae Hoon Kim,Hung Mok Park ) 한국화학공학회 1996 화학공학의이론과응용 Vol.2 No.1

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.

물량저감 중공 철근콘크리트 교각의 설계프로그램과 경제성 평가

김태훈,손윤기,양남석,이승훈,Kim, Tae-Hoon,Son, Yun-Ki,Yang, Nam-Seok,Lee, Seung-Hoon 한국전산구조공학회 2014 한국전산구조공학회논문집 Vol.27 No.5

This paper presents special-purpose design program and plastic design results for hollow RC bridge columns with reinforcement details for material quantity reduction. The developed reinforcement details has economic feasibility and rationality and makes construction periods shorter. This study documents the economic evaluation of hollow reinforced concrete bridge column systems with reinforcement details for material quantity reduction and presents conclusions based on the application findings. As a result, the proposed reinforcement details for material quantity reduction were designed prior to the existing reinforcement details in terms of structural rationality, constructability, and economic. 이 연구에서는 물량저감 철근상세를 갖는 중공 철근콘크리트 교각 시스템의 전용 설계프로그램과 소성설계 적용 결과를 제시하였다. 개발된 물량저감 철근상세는 경제성과 합리성을 갖으며 공사기간의 단축을 가져올 수 있다. 물량저감 중공 철근콘크리트 교각의 적용을 통해 경제성 평가를 수행하였다. 평가 결과 개발상세가 기존상세에 비해 구조적 합리성, 시공성, 그리고 경제성 등이 우수함을 확인하였다.

P1 근사법과 S4 방법을 이용한 흡수 , 방사 그리고 산란이 결부된 3 차원 복사계의 해석

김태훈,박흥목 ( Tae Hoon Kim,Hung Mok Park ) 한국화학공학회 1995 화학공학의이론과응용 Vol.1 No.2

깊은보-내부기둥 접합부의 비선형해석을 위한 전산플랫폼

김태훈,고동우,이한선,신현목,Kim, Tae-Hoon,Ko, Dong-Woo,Lee, Han-Seon,Shin, Hyun-Mock 한국전산구조공학회 2011 한국전산구조공학회논문집 Vol.24 No.2

이 연구에서는 깊은보-내부기둥 접합부의 내진성능평가를 위한 비선형 유한요소해석 기법을 제시하였다. 사용된 프로그램은 철근콘크리트 구조물의 해석을 위한 RCAHEST이다. 깊은보-내부기둥 접합부의 강도, 연성도 등 거동특성을 파악하기 위한 반복횡하중 실험을 수행하였다. 실험의 변수로는 축력과 횡방향 철근량을 정하였다. 이 연구에서는 깊은보-내부기둥 접합부의 내진성능평가를 위해 제안한 해석기법을 신뢰성 있는 실험결과와 비교하여 그 타당성을 검증하였다. This paper presents a nonlinear finite element analysis procedure for the seismic performance assessment of deep beam-and-interior column joints. A computer program, named RCAHEST(Reinforced Concrete Analysis in Higher Evaluation System Technology), for the analysis of reinforced concrete structures was used. Horizontal cyclic load tests were conducted to estimate the strength, ductility, and behavioral characteristics of deep beam-and-interior column joints. Experimental parameters are axial forces and amount of transverse reinforcement. The proposed numerical method for the seismic performance assessment of deep beam-and-interior column joints is verified by comparison of its results with reliable experimental results.