선천성 식도무공증의 임상적 고찰

김성철,김대연,김애란,김기수,피수영,김인구,Kim, Seong-Chul,Kim, Dae-Yeon,Kim, Ellen Ai-Rhan,Kim, Ki-Soo,Pi, Soo-Young,Kim, In-Koo 대한소아외과학회 2003 소아외과 Vol.9 No.1

This study reviews 14 years' experience treating esophageal atresia with special emphasis on the clinical profile and outcome. From May 1989 to February 2003, 65 cases of esophageal atresia (EA) were treated at Asan Medical Center. Boys outnumbered girls 2.4 to 1. Prematutity and low birth weight were 27.7% and 38.5%. Esophageal atresia with distal tracheoesophageal fistula (TEF) was the most common type (87.7%), followed by pure EA and H type fistula. Forty-six patients (70.8%) had one or more associated anomalies, cardiac malformations were the most common. Duodenal atresia was found in 7 cases. There were 6 patients (9.2 %) with VATER cluster. VACTERL cluster was present in 18 patients (27.7%), one of who fulfilled the complete syndrome. Waterston group A, B and C made up 21.5%, 40.0% and 38.5% of the total group. Surgical treatment was attempted in 63 patients and deferred in 2 who had severe associated malformations. For EA with distal TEF, primary esophago esophagostomy was carried out in 51 cases, and division of TEF and gastrostomy in 4 cases and no operation in 2 cases. For pure EA, colonic graft was done in 2 after gastrostomy and esophagostomy, and esophago esophagostomy was performed in 2 after gastrostomy. Two patients with pure EA are waiting for the second operation after gastrostomy. Division of TEF was carried out in 2 cases with H type TEF. The overall survival rate was 76.9%, and survival by Waterston classification was 100% in group A, 80.8% in B and 60.0% in C. Thorough workup for associated anomalies, interdepartmental approach and more careful surgical decision and technique are required to improve the outcome of EA.

선천성 장폐쇄증 2차 조사 - 대한소아외과학회 회원을 주 대상으로 한 전국조사 -

김성철,김대연,김상윤,김인구,김인수,김재억,김재천,김현영,박귀원,박우현,박진영,서정민,설지영,오수명,오정탁,이남혁,이명덕,이석구,이성철,정상영,정성은,정연준,정풍만,최금자,Kim, Seong-Chul,Kim, D.Y.,Kim, S.Y.,Kim, I.K.,Kim, I.S.,Kim, J.E.,Kim, J.C.,Kim, H.Y.,Park, K.W.,Park, W 대한소아외과학회 2010 소아외과 Vol.16 No.1

본 조사는 2007년부터 2009년까지 3년간 본 학회 정회원들에 의하여 수술받은 장폐쇄증 환아를 대상으로 한 후향적 조사이다. 또한 본 학회에서는 1994년부터 1996년까지 3년간의 증례를 대상으로 같은 조사(1 차조사)를 진행한 바 있다. 1 차 조사와 비교하여 본 조사에서 보이는 특징은 아래와 같이 요약할 수 있다. - 총 증례 수는 비슷하였으나 출생률을 감안하여야 할 것이다. - 각 기형별 비율은 비슷하였다. - 미숙아 및 저출생체중아의 비율은 증가 하였다. - 산전진단율은 증가하였다. - 복부단순촬영만 한 경우는 감소하였다. - 다른 기형이 동반된 예가 증가하였다. - 사망률이 13.8 %에서 3.6 %로 감소하였다. 장운동의 회복은 공장폐쇄증에서 십이지장이나 회장폐쇄증에서 보다 더뎠다. 하지만 십이지장-공장 이행부에서 문합부까지의 거리가 기술되지 않은 예가 많아 소위 "High Jejunal obstruction"에서의 장운동 회복기간을 알아 보지 못 하는 아쉬움이 있었다. 또한 주름형성술(plication) 또는 장의 직경을 줄이는 수술(tapering)의 효과도 시행한 예수가 작고, 문합부 위치의 기술 부족으로 알아 보지 못 하였다. 십이지장폐쇄증의 화타씨유두부와 위치 역시 향후 보다 정확한 수술기록을 토대로 조사되어야 할 것으로 생각된다. 치료 성적의 눈부신 향상은 여러 회원들의 각고의 노력과 의학의 발달에 기인한 것으로, 사망률 0 %를 향한 노력이 지속되어야 할 것이다. The members of the Korean Association of Pediatric Surgeons conducted a retrospective study of two hundred and twenty-two cases of intestinal atresia for the period from January 1, 2007 to December 31, 2009. Seventeen hospitals were involved. There were 76 duodenal, 65 jejunal, and 81 ileal atresias (3 colonic). The male to female ratio was 0.85:1 in DA and 1.34:1 in JIA. Ninety-four patients(43.3 %) were premature babies (DA 40.3 %, JA 64.6 %, IA 28.8 %), and 70 babies (32.0 %) had low birth weight (DA 38.7 %, JA 44.4 %, IA 16.0 %). Antenatal diagnosis was made in 153 cases (68.9 %). However, 27 infants (17.6 %) with antenatal diagnosis were transferred to the pediatric surgeon's hospitals after delivery. Maternal polyhydramnios was observed in 81 cases (36.59 %) and most frequent with proximal obstruction. In forty-four cases (19.8 %), only simple abdominal film was taken for diagnostic study. The associated malformations were more frequently observed in DA - 61.8 % in DA and 22.6 % in JIA. Meconium peritonitis, small bowel volvulus and intussusception were more frequently associated with ileal atresia. The overall mortality rate was 3.6 %. (Abbreviations: DA;duodenal atersia, JA;jejunal atresia, JIA;jejunoileal atresia, IA;ileal atrsia).

일란성 쌍둥이 모두에서 발생한 식도무공증

김성철,남소현,김대연,김인구,Kim, Seong-Chul,Nam, So-Hyun,Kim, Dae-Yeon,Kim, In-Koo 대한소아외과학회 2009 소아외과 Vol.15 No.2

Although the incidence of esophageal atresia (EA) is higher in twins than in singletons by two to three times, EA usually affects only one member of twins. We report one pair of twins concordant for EA. A 31-year-old healthy woman bore monozygotic female twins at 36 weeks of gestation. They weighed 2,216 and 2,480 g, respectively. They had EA with distal tracheoesophageal fistula and underwent primary esophageal anastomosis on the birth day and the $2^{nd}$ day of life, respectively. Twin A also had suspicious antral obstruction and pyloroplasty was done simultaneously with esophageal repair. She needed antral web excision for continued gastric stasis one month after $1^{st}$ operation and three balloon dilatations of the esophagus. Twin B recovered uneventfully.

소아 위식도 역류 질환의 외과적 치료

김성철,김대연,김경모,김인구,Kim, Seong-Chul,Kim, Dae-Yeon,Kim, Kyung-Mo,Kim, In-Koo 대한소아외과학회 2000 소아외과 Vol.6 No.2

Eleven children with gastroesophageal reflux disease underwent fundoplication. Eight had neurological impairment, two had hiatal hernias and one had a history of esophageal repair for esophageal atresia. The most common and significant symptom was vomiting(81.8 %), followed by recurrent respiratory infections(72.7 %) and failure to thrive(72.7 %). The most common diagnostic tool was 24 hour esophageal pH study, which showed pH less than 4 for more than 10 % of the total recorded time in 6 of 9 patients. Nissen fundoplication was performed in 10 patients. Thal fundoplication was carried out in one patient with esophageal atresia. Stamm gastrostomy was added for nutritional and/or swallowing problem in all 8 patients with neurological impairment. The median follow up period was 13 months. There was one late death of unrelated cause and one recurrence. The quality of life after antireflux surgery was greatly improved. Antireflux surgery should be done if indicated, and a simultaneous gastrostomy considered in a patient with neurological impairment.

신생아 위장관천공

김성철,김인구,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 1997 소아외과 Vol.3 No.1

Perforation of the gastrointestinal tract in neonatal period has been associated with a grim prognosis. Recently there has been some improvement in survival. To evaluate the remaining pitfalls in management, 19 neonatal gastrointestinal perforation cases from May 1989 to July 1996 were analysed retrospectively. Seven patients were premature and low birth weight infants. Perforation was most common in the ileum(56.3%). Mechanical or functional obstruction distal to the perforation site was identified in 7 cases; Hirschsprung's disease 3, small bowel atresia 3, and anorectal malformation 1. These lesions were often not diagnosed until operation. Five cases of necrotizing enterocolitis and 1 of muscular defect were the other causes of perforation. In six cases, the cause of the perforation was not identified. Perinatal ischemic episodes were associated in five cases. Overall mortality was 15.1%. Because a considerable number of gastrointestinal perforations resulted from distal obstruction, pediatric surgeon should be alert for early identification and intervention of gastrointestinal obstruction, particularly in patients that are premature and have a history of ischemia.

수순(水醇)추출법으로 조제된 오공 약침액의 생리활성 효과

김성철,서근영,이성원,박성주,김재효,안성훈,황성연,Kim, Sung-Chul,Seo, Geun-Young,Lee, Sung-Won,Park, Sung-Joo,Kim, Jae-Hyo,Ahn, Seong-Hun,Hwang, Sung-Yeoun 대한약침학회 2010 Journal of pharmacopuncture Vol.13 No.3

Reactive Oxygen Species(ROS) are continuously produced at a high rate as a by-product of aerobic metabolism. Since tissue damage by free radical increases with age, the reactive oxygen species(ROS) such as hydrogen peroxide($H_2O_2$), nitric oxide(NO). Several lines of evidence provided that ROS appears to cause to develop aging-related various diseases such as cancer, arthritis, cardiovascular disease. Our reserch objective was to examine the in vitro biological activity of Scolopendrid Pharmacopuncture, including the total poly-phenol content, DPPH radical scavenging, ABTS radical scavenging, Superoxide dismutase(SOD)-like activity, Nitrite scavenging ability. The total poly-phenol contents of Scolopendrid Pharmacopuncture was 35.859mg/L. Elctron donation ability on DPPH was 36.82%. The 2,2'-azinobis-3-ehtlbezothiazoline-6-sulfonic acid radical decolorization (ABTS) was 84.7%. The superoxide dismutase (SOD)-like activities of Scolopendrid Pharmacopuncture was 44.33%. The nitrite scavenging effects were pH dependent, and were highest at pH 1.5(45.2%) and lowest at pH 6.0(11.3%). We conclude that Scolopendrid Pharmacopuncture may be useful as potential sources of antioxidant.

경장간막 탈장

김성철,김인구,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 1996 소아외과 Vol.2 No.2

Transmesenteric hernia, a type of internal hernias, is a rare cause of intestinal obstruction. This intraperitoneal hernia has no sac and is formed by protrusion of a loop of bowel through an aperture in the mesentery. Incarceration leads to intestinal obstruction and subsequently, strangulation and gangrene of varing lengths of intestine. This is a case report of 4-year-old girl with transmesenteric herniation of the terminal ileum through a defect in its own mesentery. Strangulation of the affected bowel necessitates resection and primary anastomosis with repair of mesenteric defect. The postoperative course was uneventful. Acute intestinal obstruction in the absence of an external hernia and with no history of a previous surgical procedure suggests the possibility of an internal hernia, especially if the patient has a history of chronic intermittent abdominal distress.

PMIPv6에서 사전 인증 기법과 경로 최적화를 이용한 효율적인 핸드오버 기법에 관한 연구

김성철,문일영,조성준,Kim, Seong-Chul,Moon, Il-Young,Cho, Sung-Joon 한국정보통신학회 2010 한국정보통신학회논문지 Vol.14 No.5

PMIPv6 is a network-based mobility support scheme, proposed and standardized by NetLMM WG of IETF. It is proposed to solve problems of conventional mobility schemes, and to improve inefficiency of those. The standard document describes network components and detailed procedures to provide mobility to MN. But it describes only a handover procedure between MAGs, not between LMAs. In order to support seamless connectivity of MN efficiently, a handover procedure between LMAs is necessary. The proposed scheme in this paper utilizes a route optimization procedure to prevent inefficiency of inter-LMA tunneling scheme. At the same time, the proposed scheme utilizes a pre-authentication scheme to reduce handover latency. According to the result of performance evaluations, the proposed scheme greatly reduces handover latency, compared to conventional mobility support schemes. PMIPv6는 IETF의 NetLMM WG에서 표준화를 진행하는 네트워크 기반 이동성 지원 기법으로서, 기존의 단말 기반 이동성 지원 기법의 문제점과 비효율성을 개선하기 위해 제안되었다. IETF에서 공개한 표준 문서는 MN에게 이동성을 제공하기 위한 네트워크 구성 요소와 그 구체적인 동작 및 핸드오버 절차에 대해 서술하고 있다. 그러나 MAG간 핸드오버에 대해서만 정의되어 있고 LMA간 핸드오버에 대해서는 정의되어 있지 않다. 따라서 MN에게 보다 효율적으로 끊김 없는 인터넷 접속을 제공하기 위해서는 LMA간 핸드오버 기법이 함께 사용되어야 한다. 본 논문에서 제안하는 기법은 기존에 제안된 LMA간 핸드오버 기법의 단점인 LMA간 터널을 사용하지 않고, 경로 최적화 절차를 거쳐 효율적인 전송 경로를 사용한다. 또한 핸드오버 지연을 줄이기 위해 사전 인증 기법을 도입하였다. 성능 분석 결과에 따르면 제안하는 기법이 기존의 이동성 지원 기법에 비해 핸드오버 지연을 크게 감소시키는 것을 확인할 수 있었다.

항문직장기형의 교정

김성철,Kim, Seong-Chul 대한소아외과학회 2006 소아외과 Vol.12 No.1

Major advances in the management of anorectal malformations have been achieved during the last 20 years. Alberto Pena introduced the posterior sagittal anorectoplasty (PSARP) in 1982. He divided all the sphincteric muscles at the exact posterior midline and fully exposed the crucial anatomy. He was able to manage the associated fistula under direct vision with minimal urinary tract injury. The rectum could be placed in the middle of the sphincteric muscle complex. Even with PSARP by Alberto Pena himself, only 37.5% of all cases were considered totally continent. Anorectal malformation is still acontinuing challenge for the pediatric surgeons.

대망염전

김성철,김인구,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 1997 소아외과 Vol.3 No.1

One case of primary omental torsion in a 10 year-old, 43 kg boy is presented. He presented with a history of acute, continuous pain in the upper abdomen, aggravated by changes of position. Physical examination of his abdomen showed board-like rigidity. tenderness and rebound tenderness over the entire abdomen. The preoperative diagnosis was perforated peptic ulcer. Exploratory laparatomy revealed torsion of the greater omentum. The torsed omentum was excised and the outcome was good. Omental torsion is a rare surgical condition and is difficult to diagnose prior to operation. Therefore, in case of negative exploration for acute abdomen, the omentum should be included among the organs examined. In addition, careful search for an inflammatory focus should be made, because secondary omental torsion with intraabdominal sepsis is much more common than primary torsion.