다낭 형성 이상을 보이는 융합된 교차성 신전위 1례

서은민,심은정,이관섭,Seo, Eun-Min,Shim, Eun-Jung,Lee, Kwan-Seob 대한소아신장학회 2008 Childhood kidney diseases Vol.12 No.2

교차성 신전위는 두 개의 신장이 정중선의 같은 편에 나란히 위치하는 선천성 신장병이다. 대개 기형은 오른쪽에 있고 융합되어 있는 경우가 융합되지 않는 경우의 8배에 달한다. 교차성 신전위는 흔한 질환은 아니지만, 영아에서 복부에 낭성 종물이 만져지고 반대편에 신장이 없는 경우에는 고려해 보아야 한다. 다낭 형성 이상을 동반한 융합된 교차성 신전위는 대부분 초음파로 진단되므로 진단을 위해 더 이상의 검사가 필요하지 않은 경우가 많다. 그러나 방사선 동위원소를 이용한 신주사로 교차성 신전위의 기능여부를 파악해야 하고, 배설성 방광요로조영술로 방광요관 역류나 신우요관이행부의 협착이 있는지 확인해야 한다. 다낭 형성 이상을 동반한 융합된 교차성 신전위에 대한 연구는 거의 없는 실정으로 저자들은 발열, 복통을 주소로 내원한 3세 남아에서 초음파를 시행하여 다낭 형성 이상을 동반한 융합된 교차성 신전위 1례를 경험하였기에 보고하는 바이다. Crossed renal ectopia is a congenital malformation in which both kidneys lie on the same side of the spine, usually side by side longitudinally. More often on the right side. Fusion of the two renal units is eight times more common than nonfusion. Although crossed renal ectopia is uncommon, this unusual entity must be considered in an infant when cystic mass in the abdomen or pelvis paticularly if no kidney can be found on the opposite side. In many cases of crossed fused ectopia with multicystic dysplastic kidney(MCDK), the diagnosis can be strongly suspected from the sonogram, and no other studies may be necessary. However, both intravenous urography and isotope renography is useful to assess the function of the crossed kidney. Crossed renal ectopia and MCDKs are associated with a greater incidence of ureteropelvic junction obstruction and reflux. So, screening voiding cystourethrography should be performed. Very few studies of MCDK in the setting of crossed fused ectopia have been reported. We have experienced a 3-year-old boy with crossed fused renal ectopia with multicystic dysplasia.

Activation of PPARα Attenuates IFNγ and IL-1β-induced Cell Proliferation in Astrocytes: Involvement of IL-6 Independent Pathway

이진구,서은민,이상수,박수현,신윤범,정준섭,서홍원,김선미 대한약리학회 2010 The Korean Journal of Physiology & Pharmacology Vol.14 No.3

The present study demonstrates the effect of fibrates, agonists of PPARα on cytokines-induced proliferation in primary cultured astrocytes. Alone or combination treatment with cytokines, such as IL-1β (10 ng/ml), IFNγ (10 ng/ml), and TNF-α (10 ng/ml) cause a significant increase of cell proliferation in a time-dependent manner. Treatment of astrocytes with bezafibrate and fenofibrate (0, 5, and 10 μM) reduced the IFNγ and IL-1β-induced cell proliferation in a dose-dependent manner. To address the involvement of IL-6 on the IFNγ and IL-1β-induced cell proliferation, released IL-6 level was measured. IFNγ and IL-1β cause an increase of released IL-6 protein level in a time-dependent manner. Furthermore, pretreatment with IL-6 antibody (0, 0.1, 1, 2.5, and 5 ng/ml) dose-dependently inhibited the IFNγ and IL-1β-induced cell proliferation. However, bezafibrate and fenofibrate did not affect increased mRNA and protein levels of IL-6 in IFNγ and IL-1β-stimulated astrocytes. Taken together, these results clearly suggest that activation of PPARα attenuates the IFNγ and IL-1β-induced cell proliferation through IL-6 independent pathway.

직장루가 합병된 제 5요추-1천추간 수술 후 추체-추간판염 - 증례 보고 -

이상훈,서은민,최성일,김기택 대한척추외과학회 2009 대한척추외과학회지 Vol.16 No.3

To our knowledge, there are no reported cases of rectal fistula complicating spondylodiscitis. We report the first case of a rectal fistula communicating with the site of postoperative recurrent spondylodiscitis. A-59-year-old female had recurrent spondylodiscitis after an open discectomy for L5-S1 eight years earlier. She underwent three operations including two anterior lumbar interbody fusion procedures after an open discectomy. Radiographic studies revealed severe bony destruction with abscess collection within the L5-S1 intervertebral disc space with fistula formation into the rectum. The fistula was confirmed by a Barium enema colon study and sigmoidscopy. The patient underwent a staged operation consisting of a rectosigmoid colon resection, anterior interbody fusion and posterior instrumented fusion. Rectum related complications were suspected in this case of recurrent spondylodiscitis. 직장루가 합병된 술 후 추체-추간판염에 대한 보고는 없었다. 이에 저자들은 직장루가 합병된 제 5요추-1천추간 추 체-추간판염 1례를 치험하였기에 보고 하고자 한다. 제 5요추-1천추간 수핵 절제술 후 수 차례 전방 추체간 유합술 후에도 지속 되고 있는 재발성 추체-추간판염으로 내 원한 59세 여자 환자로 방사선 소견상 추간판 공간에 심한 골 결손 및 농양형성 소견을 보였으며 전방의 직장과 연결 이 의심되었다. S 상결장경 검사 및 바륨(Barium)관장결장 검사에서 직장-S상 결장 연결부위에서 제 5요추-1천추간 추간판 공간과 연결되는 직장루를 확인하여 단계적 직장 절제술, 전방 추체간 골유합술 및 후외측 골유합술로 치료 하였다. 본 증례의 경우와 같이 특이한 위험인자 없이 만성적으로 재발되는 추체-추간판염에서 직장과 연관된 합병 증의 가능성도 고려해야 할 것으로 판단된다.

후경골 동맥 유리 피판에 의한 수부 전기 화상의 재건

최수중,서은민,이창주,장준동,김석우,이상훈,이동훈,서영진,Choi, Soo-Joong,Seo, Eun Min,Lee, Chang Ju,Chang, Jun Dong,Kim, Suk Wu,Lee, Sang Hun,Lee, Dong Hun,Seo, Young jin 대한미세수술학회 2004 Archives of reconstructive microsurgery Vol.13 No.1

Introduction: The hand and wrist are particularly susceptible to electrical burn. Skin defect with damage or exposure of underlying vital structure requires coverage by skin flap especially in case of the need for late reconstruction. We are reporting 4 cases of electrical burned hand treated by posterior tibial arterial free flap. The commonly used skin flaps such as scapular flap or groin flap are too bulky so that they are not satisfactory in function and cosmetic appearance. So we tried to cover them with a more thin skin flap. Materials and Method: From January 2002 to June 2003, four cases of hand and wrist electrical burn were covered using posterior tibial arterial free flap. All the cases were due to high voltage electrical burn. Age ranged from 31 years to 38 years old and all the cases were male patients. Recipient sites were 2 wrist, one thenar area and one knuckle of 2.3rd MP joint. Additional procedures were flexor tenolysis (simultaneous), FPL tenolysis and digital nerve graft (later) and extensor tendon reconstruction (later). Result: All the flap have survived totally without any complication including circulatory concern about the donar foot. Posterior tibail arterial free flap was so thin that debulking procedure was not required. Conclusion: For skin coverage of the hand & wrist region, posterior tibial arterial free flap have many advantages such as reliable anatomy, easy dissection and easy anastmosis with radial or ulnar artery and possibility of sensory flap. The most helpful advantage for hand coverage is its thinness. So we think this flap is one of the very useful armamentarium for reconstructive hand surgery.

소아에서의 일과성 소장형 장중첩증의 임상적 고찰

허지승,심은정,서은민,조도준,김덕하,민기식,유기양,이관섭 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.5

Purpose:We analyzed the clinical features, management and outcome of small bowel intussusception in children compared with ileocolic intussusception. Methods:We retrospectively reviewed the records of 210 children with documented intussusception, in whom intussusception was initially diagnosed by ultrasonography during the four-year period of 2002 to 2005. Results:A total of 191 children were diagnosed with ileocolic intussusception and 19 were diagnosed with small bowel intussusception. Children with small bowel intussusception were older than children with ileocolic intussusception (P<0.05). In comparison to patients with ileocolic intussusception the characteristic presenting symptoms­such as currant jelly stool and palpable mass­were rarely observed in patients with small bowel intussusception. In ileocolic intussusception, air reduction (92.2%), or surgical reduction (7.3%) was performed; however, in small bowel intussusception, spontaneous reduction (78.9%) was observed and no surgical reduction was required in our study. Conclusion:Conservative management with close observation and follow-up sonographic evaluation rather than an immediate operation is recommended for children with small bowel intussusception. (Korean J Pediatr 2008;51: 500- 505) Purpose:We analyzed the clinical features, management and outcome of small bowel intussusception in children compared with ileocolic intussusception. Methods:We retrospectively reviewed the records of 210 children with documented intussusception, in whom intussusception was initially diagnosed by ultrasonography during the four-year period of 2002 to 2005. Results:A total of 191 children were diagnosed with ileocolic intussusception and 19 were diagnosed with small bowel intussusception. Children with small bowel intussusception were older than children with ileocolic intussusception (P<0.05). In comparison to patients with ileocolic intussusception the characteristic presenting symptoms­such as currant jelly stool and palpable mass­were rarely observed in patients with small bowel intussusception. In ileocolic intussusception, air reduction (92.2%), or surgical reduction (7.3%) was performed; however, in small bowel intussusception, spontaneous reduction (78.9%) was observed and no surgical reduction was required in our study. Conclusion:Conservative management with close observation and follow-up sonographic evaluation rather than an immediate operation is recommended for children with small bowel intussusception. (Korean J Pediatr 2008;51: 500- 505)

Arthroscopic Percutaneous Repair of Anterosuperior Rotator Cuff Tear Including Biceps Long Head: A 2-Year Follow-up

김도영,유연식,이상수,서은민,황정택,Sun-Chang Kwon,Jae-Won Lee 대한정형외과학회 2012 Clinics in Orthopedic Surgery Vol.4 No.4

Background: To report the results of an arthroscopic percutaneous repair technique for partial-thickness tears of the anterosuperior cuff combined with a biceps lesion. Methods: The inclusion criteria were evidence of the upper subscapularis tendon tear and an articular side partial-thickness tear of the supraspinatus tendon, degeneration of the biceps long head or degenerative superior labrum anterior-posterior, above lesions treated by arthroscopic percutaneous repair, and follow-up duration > 24 months after the operation. American Shoulder and Elbow Surgeons (ASES) score, constant score, the pain level on a visual analogue scale, ranges of motion and strength were assessed. Results: The mean (± standard deviation) age of the 20 enrolled patients was 56.0 ± 7.7 years. The forward flexion strength increased from 26.3 ± 6.7 Nm preoperatively to 38.9 ± 5.1 Nm at final follow-up. External and internal rotation strength was also significantly increased (14.2 ± 1.7 to 19.1 ± 3.03 Nm, 12.3 ± 3.2 to 18.1 ± 2.8 Nm, respectively). Significant improvement was observed in ASES and constant scores at 3 months,1 year and the time of final follow-up when compared with preoperative scores (p < 0.001). The mean subjective shoulder value was 86% (range, 78% to 97%). Conclusions: The implementation of complete rotator cuff repair with concomitant tenodesis of the biceps long head using arthroscopic percutaneous repair achieved full recovery of normal rotator cuff function, maximum therapeutic efficacy, and patient satisfaction.

만성 견봉하 및 삼각근하 점액낭염에 발생한 다발성 쌀소체의 수술적 치료: 증례 보고

김도영,황정택,이상수,서은민,조윤걸,Kim, Do-Young,Hwang, Jung-Taek,Lee, Sang-Soo,Seo, Eun-Min,Jo, Yoon-Geol 대한근골격종양학회 2013 대한골관절종양학회지 Vol.19 No.2

견봉하 및 삼각근하 만성 점액낭염에 발생한 다발성 쌀소체의 치료에 대해 고찰하였다. 다발성 쌀소체의 형성은 혈청음성의 류마티스 관절염 혹은 결핵과 자주 연관된 만성 점액낭염의 합병증으로 형성된다. 또한 이것은 윤활막 뼈연골종증과 영상학적 및 임상적으로 비슷한 양상을 보인다. 저자들은 만성 삼각근하 및 견봉하 점액낭염에 발생한 다발성 쌀소체가 있어 관혈적 수술을 통해 제거한 44세 남자를 증례 보고하고자 한다. 제거술을 시행한 지 16개월 후 견관절의 운동 범위 및 근력은 정상 범위에 있었고 기능도 만족스러웠다. 일반 촬영 및 초음파 검사에서 쌀소체의 재발은 없었다. 견봉하 및 삼각근하 만성 점액낭염에 발생한 다발성 쌀소체는 점액낭을 포함한 관혈적 절제술에 의해 성공적으로 치료 될 수 있었다. Multiple rice body formation is a complication of chronic bursitis frequently associated with seronegative rheumatoid arthritis or tuberculosis. It resembles synovial chondromatosis on imaging and clinically. We report on a pathologically diagnosed multiple rice body formation in subacromial and subdeltoid bursitis in a 44-year-old man who was treated by surgical removal and bursectomy. At 16 months after the removal, range of motion of affected shoulder was normal. No evidence of recurrence of rice body in plain X-ray and ultrasonography. Multiple rice body formed in chronic subacromial and subdeltoid bursitis could be treated with surgical removal and bursectomy successfully.

다분절 요추관 협착증에서 시행한 선택적 광범위 감압술 및 연성 고정술 - 단기 추시 결과-

김기택,이상훈,석경수,이정희,서은민,곽윤호 대한척추외과학회 2009 대한척추외과학회지 Vol.16 No.3

Study Design: A prospective study Objectives: We wanted to assess the clinical outcomes of posterior dynamic stabilization with selective wide decompression for treating multilevel lumbar stenosis in old age. Summary of Literature Review: Deciding on the segments to be operated on is challenging problem for old age patients with multilevel lumbar stenosis. There have been no reports on posterior dynamic stabilization with selective wide decompression for treating multilevel lumbar stenosis. Materials and Methods: We evaluated 18 patients who underwent posterior dynamic stabilization with selective decompression for multilevel disc degeneration and spinal stenosis. The mean age was 70.2 years and mean follow-up was 15.1 months. We evaluated the segmental angle, the range of motion (ROM) and pedicle screw loosening. The clinical results were evaluated according to the operative time, blood loss, the visual analogue scale (VAS) for the back pain and leg pain and and the Oswestry disability index (ODI). Results: The mean number of operated segments was 2.16. The lordosis of the lumbar and operated segments showed no significant difference. However, the ROM of the total lumbar spine and the operation segment was significantly decreased from 36.8 to 24.3 and 22.9 to 13.1, respectively. The ROM for the adjacent segment did not show a significant difference. A radiolucent line around the pedicle screw appeared at 22 screws (19.3%) out of a total 114 screws. The VAS for back and leg pain were improved from 7.5 and 8.6 to 2.3 and 2.1, respectively. The ODI was improved from 41.5 to 13.4. Conclusions: The initial clinical outcomes were favorable after posterior dynamic stabilization with selective decompression. This procedure could be considered to be a useful option for treating multilevel stenosis in old age patients. 연구계획: 다분절의 심한 퇴행성 변화가 동반되어 있는 척추관 협착증의 수술 분절 결정은 쉽게 결론 내리기 어려운 문제로 선택적 광범위 감압술 및 후방연성 고정술에 대하여 전향적 연구를 시행하였다. 연구목적: 고령의 다분절 협착증 환자에서 선택적 광범위 감압술 및 후방연성 고정술을 시행한 임상 결과를 보고하 고자 하였다. 대상 및 방법: 3분절 이상의 추간판 퇴행성 변화와 척추관 협착증을 동반한 환자에서 주 증상을 유발할 것으로 판단 되는 분절에 본 술식을 시행한 18예를 대상으로 하였으며 평균 연령은 70.2세, 추시 기간은 15.1개월이었다. 방사선 학적으로 전만각과 분절간 운동범위, 척추경나사못 이완여부를 분석하였으며 임상적으로는 수술 시간 및 실혈량, 요통 및 하지 통증의 Visual analogue scale (VAS)과 Oswestry Disability Index (ODI)의 변화를 분석하였다. 결과: 평균 수술 분절은 2.16분절이었으며 요추 전만각과 수술 분절의 전만각은 유의한 차이를 나타내지 않았으나 전 체요추의 운동범위 및 수술 분절의 운동범위는 수술 전 36.8도와 22.9도에서 추시 시 24.3도와 13.1도로 유의하게 감소 하였다. 수술 분절당 운동범위는 술 전 10.8도에서 5.8도로 감소되었으며 수술 부위 인접분절의 운동범위는 유의한 변 화를 나타내지 않았다. 척추경 나사못 주위의 방사선 투과성 음영은 전체 나사못 114개 중 22개(19.3%)에서 나타났다. 술 전 요통과 하지 통증은 VAS 7.5와 8.6에서 2.3과 2.1로 호전되었으며 ODI는 41.5에서 13.4로 호전되었다. 결론: 고령의 다분절 퇴행성 질환에서 증상을 유발하는 분절 만을 광범위하게 감압한 후 보조적인 고정을 시행하여 양호한 임상적 결과를 얻었으며 장기적인 추시 결과는 아직 알 수 없으나 유합술에 따르는 다양한 합병증을 피할 수 있는 하나의 선택으로 고려할 수 있다고 생각된다.

신경섬유종증에서 발생한 자발성 척주탈구 - 증례 보고 -

김기택,이상훈,석경수,이정희,서은민,정비오 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.6

신경섬유종 척추측만증의 이영양성 만곡은 다양한 비전형적인 형태를 보이나 진행성 신경학적 증상을 보이는 자발성 척추체 탈구에 대해서는 보고된 바가 거의 없다. 저자들은 외상력 없이 척추의 후방구조물의 연속성은 유지된 상태에서 흉추체의 탈구를 보인 증례를 보고하는 바이다. 5년간 지속된 체간의 전방굴곡 및 요통을 호소하는 35세 여자로 최근 3개월 전부터 진행성 양측 하지 운동마비소견을 보였으며 방사선 소견 상 흉추 5, 6번 척추경의 심한 골흡수 소견 및 흉추 5, 6번 사이의 관상면 및 축상면 전위를 보이는 탈구 소견을 나타내었다. 골견인 후 전, 후방 유합술을 시행하였으며 술 후 신경학적 증상은 호전을 보여 술 후 24개월에 독립 보행이 가능하였다. 색인단어: 신경섬유종, 자발성 척추체 탈구, 이영양성 후측만증 10.Winter RB, Lonstein JE, Anderson M: Neurofibromatosis hyperkyphosis: a review of 33 patients with kyphosis of 80 degrees or greater. J Spinal Disord, 1: 39-49, 1988.

요골 원위부 골절에 합병된 장무지 굴곡건 파열 -증례 보고-

김도영 ( Do Young Kim ),서은민 ( Eun Min Seo ),남우동 ( Woo Dong Nam ),박승재 ( Seung Jae Park ),이상수 ( Sang Soo Lee ) 대한골절학회 2011 대한골절학회지 Vol.24 No.2

요골 원위부 골절에 합병된 장무지 신전건 파열은 종종 보고되었으나, 장무지 굴곡건 파열은 보고된 예가 극히 드물다. 저자들은 개방성 창상이 없이 원위부 요골 골절에 합병된 장무지 굴곡건 파열을 1예 치험하였기에 문헌 고찰과 함께 보고하는 바이다. 24세 남자 환자로 전위가 심한 요골 원위부 골절에 대해 도수 정복술을 시행받고, 3일째 무지 지관절 굴곡 운동제한과 전완부의 통증을 호소하였다. 이학적 검진상 장무지 굴곡건 파열이 의심되어 탐색술을 시행하였다. 수술 소견상 요골 골절부위에서 장무지 굴곡건의 파열을 확인할 수 있었고, 건봉합술과 골절부위에 대해 수장부 금속판 고정술을 시행하였다. 요골 원위부 골절 시 신전건뿐만 아니라 굴곡건의 파열도 합병될 가능성을 고려하여, 면밀한 이하적 검진을 시행하여야 하겠고, 특히 도수 정복술을 시행하였을 경우 더욱 세심한 관찰이 필요하다. There are few reported cases of flexor pollicis longus tendon (FPL) rupture complicating a closed distal radius fracture. We report a case of FPL tendon rupture complicating a closed distal radius fracture. A 24-year-old male presented with a severe right wrist pain. He had a closed distal radius fracture that was treated by closed manual reduction. Three days later, he complained forearm pain and limitation of thumb motion. The physical examination revealed loss of active interphalangeal joint flexion of thumb. He was taken to the operating room. Intraoperatively, the FPL was found to be discontinuous at the level of the radius fracture site. The FPL was repaired by a modified Kessler technique, and the fracture was repaired with a volar plate. Clinicians must be cautious in possibility of tendon injury complicating a closed distal radius fracture and assessing patients with distal radius fracture following closed reduction.