담관의 자연 천공

유수영,박용태,최승훈,황의호,Yoo, Soo-Young,Park, Yong-Tae,Choi, Seung-Hoon,Hwang, Eui-Ho 대한소아외과학회 1996 소아외과 Vol.2 No.2

Spontaneous perforation of the bile duct in children is a very rare disorder. We experienced a 6 year-old girl with spontaneous perforation of the right hepatic duct. The patient was initially misdiagnosed as hepatitis because of elevation of liver enzyme and then as appendicitis because of fluid collection in the pelvic cavity demonstrated by ultrasonogram. A laparoscopic exploration was done and no abnormal findings were detected except bile-stained ascites. Peritoneal drainage was performed and the patients seemed to improve clinically. Abdominal pain, distention and high fever developed after removal of the drains. DISIDA scan showed a possible of bile leak into the peritoneal cavity. ERCP demonstrated free spill of dye from the right hepatic duct. At laparotomy, the leak was seen in the anterior wall of the right hepatic duct 2cm above the junction of the cystic duct and common hepatic duct. The perforation was linear in shape and 0.8cm in size. The patient underwent cholecystectomy, primary closure of the perforation and T-tube choedochostomy. We could not identify the cause of the perforation; however, the T-tube cholangiography taken on the 42nd postoperative day showed a little more dilatation of the proximal common bile duct compared with the cholangiography taken on the 14th day. Long-term follow-up of the patient will be necessary because of the possibility for further change of the duct.

어린 백서에서 패혈증으로 유발된 다발성 장기 부전증의 특성

유수영,노광수,정진형,김일호,고용택,Yoo, Soo-Young,Roh, Kwang-Soo,Jung, Jin-Hyung,Kim, Il-Ho,Ko, Yong-Taek 대한소아외과학회 2000 소아외과 Vol.6 No.1

Multisystem organ failure resulting from gram negative bacterial sepsis is associated with high morbidity and mortality in surgical neonates. There are differences in the clinical characteristics of organ failure in neonates and adults. The purpose of this study is to identify the differences and determine the order of organ failure between baby rats and adult rats after induction of gram negative sepsis. Fifty baby rats less than 30-day-old and another 50 adult rats more than 2-month-old were divided into control group (G1) and experimental group (G2). The G1 consisted of 10 baby- and 10 adult-rats, and the G2 consisted of 40 babies and 40 adults. E. coli ($10^8/mL$ per 100g of body weight) were injected into the peritoneal cavity in G2 and same amount of saline was injected in G 1. Blood samples were obtained before injection, 24 hour, 48 hour, 72 hour and after death. WEC, platelet, $PaO_2$, $PaCO_2$, total bilirubin, BUN, creatinine, albumin and abdominal wall thickness were measured to evaluate the sequence of organ failure. The mortality was 55.0 % in G2-babies and 32.5 % in G2-adults. In baby rats, microvascular, hematologic and renal failure appeared within 24 hours after injection and pulmonary failure followed. Pulmonary, renal and liver failure developed within 24-48 hours in adult rats; however, microvascular failure did not appear until they were moribund. Thrombocytopenia, hypoalbuminemia, increased BUN and generalized edema was the earlist sign of sepsis in baby rats.

Hirschsprung's Disease의 감별 진단

유수영,Yoo, Soo-Young 대한소아외과학회 2002 소아외과 Vol.8 No.1

Hirschsprung's disease (HD) is usually diagnosed in the newborn period and early infancy. The common presentation of HD in newborns consists of a history of delayed passage of meconium within the first 48 hours of life. The differential diagnosis in newborns is one of the clinical challenges of this disorder. A number of medical conditions which cause functional obstruction of the intestines are easily excluded. Neonates with meconium ileus, meconium plug syndrome, distal ileal atresia and low imperforate anus often present in a manner similar to those with HD in the first few days of life. Abdominal radiographs may help to diagnose complete obstruction such as intestinal atresia. Microcolon on contrast enema can be shown in cases with total colonic aganglionosis, ileal atresia or meconium ileus. Suction rectal biopsy or frozen section biopsy at operation is essential for differential diagnosis in such cases. HD is also considered in any child who has a history of constipation regardless of age. Older children with functional constipation may have symptoms that resemble those of HD and contrast enema is usually diagnostic. However, children with other motility disorders generally referred to as chronic idiopathic intestinal pseudoobstruction present with very similar symptoms and radiographic findings. These disorders are classified according to their histologic characteristics.; visceral myopathy, visceral neuropathy, intestinal neuronal dysplasia (IND), hypoganglionosis, immature ganglia, internal sphincter achalasia. Therefore, the workup for motility disorders should include rectal biopsy not only to confirm the presence of ganglion cells but also evaluate the other pathologic conditions.

선천성 거대결장 및 특발성 거대결장에서 카할 세포의 역할

유수영,고용택,한애리,정순희,엄민섭,김일호,Yoo, Soo-Young,Koh, Yong-Taek,Han, Ai-Ri,Jung, Soon-Hee,Eom, Min-Seob,Kim, Il-Ho 대한소아외과학회 2002 소아외과 Vol.8 No.2

The etiology of several motility disorders, including persistent megacolon after definitive surgery for Hirschsprung's disease, meconium ileus which is not associated with cystic fibrosis and idiopathic megacolon, is still unclear. Interstitial cells of Cajal (ICC) are thought to modulate gut motility as gastrointestinal pace maker cells. The aim of this study was to evaluate the role of ICC in the bowel walls of the patients (n=15) who had variable motility disorders. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. The ICC were immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. Whereas ICC were evenly distributed in the ganglionic bowels of G2, they were not seen or scarecely distributed in the ganglionic bowels of G3. Two patients (G4) who suffered from idiopathic megacolon showed absence or decrease of ICC in spite of presence of ganglion cells in their colons. Four neonates (G5) who underwent ileostomy because of meconium obstruction showed absent or markedly decreased ICC in the the colon at the time of ileostomy and the distribution of ICC was changed to a normal pattern at the time of ileostomy closure between 39-104 days of age and their bowel motility were restored after that. The results suggest that lack of ICC caused reduce motility in the ganglionic colons and it may be responsible for the development of various motility disorders. Delayed maturity of ICC may also playa role in the meconium obstruction of neinates.

소아 외상 환자에서 외상 정도의 예측 인자

유수영 ( Soo Young Yoo ),김익용 ( Ik Yong Kim ),강병욱 ( Byung Wook Kang ),임경수 ( Kyung Soo Lim ),강성준 ( Seong Joon Kang ) 대한외상학회 1990 大韓外傷學會誌 Vol.3 No.2

Trauma is the leading cause of death in the Korean pediatric population. Initial correct assessment of injury severity is necessary to reduce preventable traumatic deaths and it can help the appropriate patient to be referred to the appropriate facility. Injury Severity Score(ISS) system widly used for categorizing the severity of injury requires many clinical datas including radiologic modalities, therefore, it does not provide a quick assessment. Five hundreds and eighty-four injury patients less than sixteen years of age were prospectively assessed for 6 month from May 1, 1990 to October 31, 1990. All patients were initially assessed for mechanism of injury, age, direct or referred admission, time from injury, anatomical site of injury, blood cell count and pediatric trauma score(PTS). After diagnostic procedure or operation, the patients were reevaluated with ISS. Motor vehicle related injuries accounted for 42.9% of all deaths and pedestrian injuries of them caused the greatest number of deaths. The patients referred from local hospitals had the prolonged time interval from injury to arrival and higher mortality rate. We have observed a significantly higher death rate among trauma patients younger than 8 year-old. Anatomically, thoracic or abdominal injury presented higher mortality rate than the other site did. All mortality cases had PTS 4 or below, and ISS above 20. A decreasing PTS was directly associated with an increasing ISS. Count of leucocyte, band-form neutrophil or lymphocyte presented linear relationship with ISS and the parients with total leucocyte count more than 20,000/mm3, lymphocyte more than 4,000/mm3, band-form neutrophil more than 500/mm3 disclosed far more death rate (p< 0.0001). We have concluded that quick assessment of injury patients with evaluation of anatomical injury site, severity scoring with PTS, and blood cell count are readily available means of identifying the high risk patients.

소아의 배아세포 종양

유수영(Soo Young Yoo),박덕훈(Deok Hoon Park),윤광수(Kwang Soo Yoon),강성준(Seong Joon Kang),노병선(Byoung Seon Rhoe) 대한외과학회 1989 Annals of Surgical Treatment and Research Vol.36 No.2

항문직장 기형

유수영(Soo Young Yoo),김대성(Dae Sung Kim),강성준(Seong Joon Kang) 대한외과학회 1987 Annals of Surgical Treatment and Research Vol.33 No.2

복막염시 Povidone-Iodine 용액의 복강세척에 관한 임상적 연구

유수영(Soo-Young Yoo),노병선(Byong-Sun Rhoe),김수용(Soo-Yong Kim),김세환(Sae-Whan Kim) 대한외과학회 1980 Annals of Surgical Treatment and Research Vol.22 No.12

위장관 ( 胃腸管 ) : 소아에서 약물에 의한 소화성 궤양의 특성 및 합병증에 관한 고찰

유수영(Soo Young Yoo),조남천(Nam Chun Cho),강병욱(Byung Wook Kang) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4

N/A Peptic ulcer disease in early childhood is a relatively rare condition. Secondary ulcers, stress ulcer or drug-induced ulcer are more common in younger children. We experienced thirteen children less than 10-year old complicated drug-induced ulcers for last seven years. Ulcer perforations occurred in 8children who had steroid therapy and 5 children took aspirin had acute gastric ulcers with bleeding. In all cases with steroid-induced ulcer, generalized urticaria was the primary insult. The duration of steroid or aspirin therapy was only 3 to 5 days and daily dose did not exceed the mormal usual dosage. The ocurrence of drug-induced ulcers did not seem to be dose-dependent in this series.The diagnosis of the ulcer periorations was made by plain abdomial roentgenogram and in 5 patients with ulcer bleeding, the diagnosis was made by either endoscopy or barium meal. Morphologically, steroid-induced ulcers resimbled chronic peptic ulcers in adult, being duodenal, single and deeply penetrating prone to perforate compared with asprin-induced ulcers being gastrin, multiple and shallow prone to bleeding. Microscopic findings were also different. Mucosal destruction and the inliltration of infalmmatory cells,mainly eosinopgils, to the granulation tissue of the serosa were siin in the steroid-induced ulcers. In cases with asprin-induced ulcers, the mucasal layer was abruptly desquamated wuthout granulation tissus formation.Surgery was necessary for all patients with perforted ulcers and all bleeding ulcers recovered with conservative management.

Omphalocele과 동반된 제대부 기형

유수영(Soo Young Yoo),이창일(Chang Il Lee),강성준(Seong Joon Kang),노병선(Byung Seon Rhoe) 대한외과학회 1990 Annals of Surgical Treatment and Research Vol.39 No.5