H형 기관지 식도루에 대한 임상 경험

조휘동,남소현,조민정,김태훈,김대연,김성철,김인구,Cho, Hwui-Dong,Nam, So-Hyun,Cho, Min-Jeng,Kim, Tae-Hoon,Kim, Dae-Yeon,Kim, Seong-Chul,Kim, In-Koo 대한소아외과학회 2011 소아외과 Vol.17 No.2

Tracheoesophageal fistula without esophageal atresia (H-type TEF) is a congenital anomaly that is characterized by a fistula between the posterior wall of the trachea and the anterior wall of the esophagus, not accompanied by esophageal atresia. The purpose of this study is to investigate the clinical characteristics, diagnostic time, the side of cervical approach and short term result after surgery by searching medical records of patients treated for H-type TEF. The search was done at University of Ulsan, Department of Pediatric Surgery of Asan Medical Center, and the total number of patients from May 1989 to December 2010 was 9 with M:F ratio of 1:2. The median gestational age was $39^{+6}$ ($32^{+6}{\sim}41^{+0}$) wks. Seven out of nine patients were born at term and the other two were born premature. The clinical presentation was aspiration pneumonia, difficulty in feeding, chronic cough, vomiting, abdominal distension and growth retardation. The symptoms presented right after birth. The diagnosis was made with esophagography and the median time of diagnosis was 52 days of life. The majority of surgical corrections were performed within two weeks of diagnosis (median; 15d, range; 1d - 6m). Six patients had associated anomalies, and cardiac anomalies were most common. The cervical approach was utilized in all cases (right 2, left 7). Transient vocal cord palsy and minor esophageal leakage complicated two cases. Although the diagnosis of H-type TEF was difficult and often delayed, we had a good short term result. The left cervical approach was preferred.

총담관결찰후 집토끼 Paneth세포의 변화에 대한 면역전자현미경적 연구

박경호,조휘동,양남길,안의태,고정식,김진국,Park, Kyung-Ho,Cho, Hwee-Dong,Yang, Nam-Gil,Ahn, E-Tay,Ko, Jeong-Sik,Kim, Jin-Gook 한국현미경학회 1994 Applied microscopy Vol.24 No.2

Lysozyme has been reported to be present in the secretory granules of the Paneth cell, and lysozyme immunoreactivity has been detected by immunogold method in Paneth cells of the intestine of human, mouse and rat. The present study was aimed at clarifying the intracellular distribution and changes of the lysozyme immunoreactivity in rabbit Paneth cell after common bile duct ligation of rabbit, using the electron microscope immunogold technique. Healthy adult rabbits weighing about 2kg body weight were divided into normal and bile duct ligated groups. Common bile duct ligation was performed aseptically under ether anesthesia. Experimental animals were sacrificed on the 1st, the 3rd, the 5th, the 7th and the 14th day after the operation. Mucosal specimens from the intestinal gland of ileum were fixed in 2.5% glutaraldehyde-1.5% paraformaldehyde, followed by 1% osmium tetroxide, embedded in araldite mixture, cut with LKB-V ultratome. Ultrathin sections were placed on parlodion coated nickel grids (200mesh). The section-bearing grids were floated upside down on the added substance in a moist chamber at room temperature except for the primary antibody step, which was at $4^{\circ}C$. Sections were etched with a saturated solution of sodium m-periodate for 60min. After etching, sections were pretreated with 0.02M tris buffered saline (TBS), pH 8.4, with 1% bovine serum albumin (BSA, Sigma) for 60min, then treated polyclonal rabbit anti-human lysozyme (Dakipatts) diluted 1 : 50 in TBS with 0.1% BSA for 20hr. Subsequently, grids were incubated 60min in biotinylated goat anti rabbit IgG (Amersham) diluted 1 : 100 in TBS with 0.1% BSA. After this, sections were incubated 60min on streptavidin gold G10 (Amersham) diluted 1 : 50 in TBS with 0.1% BSA. After each step, the grids were briefly rinsed with TBS with 0.1% BSA. After the strepavidin gold step, the sections were jet washed with distilled water. Counterstain of the sections performed by uranyl acetate and lead citrate, and observed with JEM 100 CX II electron microscope. Observed results were as follow; 1. Secretory granules of mouse Paneth cells have a lysozyme immunoreactivity and also eosinophil leucocyte of rabbit applied for the positive-control stain, are well labeld with gold particles. 2. Normal rabbit Paneth cells have a lysozyme immunoreactivity restricted on the secretory granules. 3. Amount lysosomes containing myelin figures in the Paneth cells were significantly increased from 5th day after the common bile duct ligation. 4. Immunoreactivity of Paneth cell secretory granules were more activated on the 3rd day after the common bile duct ligation as compared with those of the normal animal. But the lysozyme immunoreactivity were decreased from the 5th day after the common bile duct ligation. 5. Considering the above finding, lysozyme contained Paneth cell are affected following of common bile duct ligation, whereas lysosomes containing myelin-figure do not exhibit any immunoreactive relationship with those of secretory granules.

비주 결손의 범위에 따른 피판의 선택과 재건

송상현,조혜민,박진후,정휘동,정영수 대한구순구개열학회 2018 대한구순구개열학회지 Vol.21 No.1

Congenital and acquired columella defect is rare. Columella is a small subunit of the nose, but determines the projection of nasal tip, defines the nasolabial angle, and is related to the structural relationship between alar rims and the nasal base. The showing of columella from various angles is also important for aesthetic point of view. Thus, reconstruction of columella defect is quite challengeable operation for surgeons. The recipient site should be harmonious with surrounding area, also the donor site should maintain the normal anatomy without secondary deformity. In this paper, we report two cases of reconstruction of columella defect in Vietnamese children with different techniques.

방사선이 뇌실막세포의 미세구조에 미치는 영향

안의태,조휘동,김진국,박경호,고정식,Ahn, E-Tay,Cho, Hwee-Dong,Kim, Jin-Gook,Park, Kyung-Ho,Ko, Jeong-Sik 한국현미경학회 1999 Applied microscopy Vol.29 No.1

머리 부분에 많은 양의 방사선을 조사 받은 흰쥐 뇌실막세포의 미세구조에 대하여 연구하였다. 체중 $200\sim250g$의 흰쥐를 실험동물로 사용하였고, 방사선 발생장치로는 Mitsubishi linear accelerator (ML-4MV)를 이용하였다. 실험군의 흰쥐는 sodium thiopental로 마취시킨 후 머리부분이 조사구역 $(30cm\times30cm)$ 안에 들도록 눕힌 후, 조사거리 80cm, 조사 깊이 1.2 cm의 조건에서 200 rad/min의 속도로 연속 조사하였다. 실험군에 따라 3,000 rad 또는 6,000 rad를 조사시킨 후 각각 6시간, 2일, 6일 후에 동물들을 희생시켰다. 희생시에는 마취된 흰쥐의 가슴을 열고 심장을 통한 관류고정을 시행하였고, 관류고정액은 1% glutaraldehyde-1% paraformaldehyde액을 사용했다. 고정된 뇌에서 가쪽뇌실벽 일부를 메어 관류고정액과 같은 고정액에 다시 고정한 후, 2% osmium tetroxide 액으로 이차고정 하였고, 이후 통상적인 방법으로 전자현미경 절편제작 및 염색과정을 거친 후 전자현미경으로 관찰한 결과 다음과 같은 결론을 얻었다. 1. 방사선조사후 6시간군부터 뇌실막세포는 종창현상을 보였고 섬모의 배열이 흐트러졌으며 부분적으로 세포질이 뇌실공간으로 돌출하였다. 2. 방사선조사후 2일군부터는 뇌실막세포의 종창현상이 심하며 뇌실막밑조직의 부종이 심했다. 3. 뇌실막세포의 돌출부분 세포질에는 섬모바닥체, 사립체, 세포질세망들이 들어 있었다. 4. 방사선조사군에서는 확장된 뇌실막세포사이공간을 통하여 뇌실막밑층의 축삭성분 등이 뇌실속 까지도 돌출하였다. 이와 같은 결과로 보아 방사선조사에 의해 뇌실막세포에는 심각한 형태학적 변화가 초래되며, 이로써 뇌실질과 뇌척수액사이의 대사관문이 교란될 것으로 생각된다. Ultrastructure of the ependymal cells of X-irradiated rats on their head were studied. Rats weighing $200\sim250gm$ were X-irradiated on their head and neck areas. Total exposures were 3,000 rads or 6,000 rads depending on experimental groups. And irradiated rats were sacrificed on 6 hours, 2 days and 6 days following the radiation exposures. Animals were perfused through the heart with 1% glutaraldehyde-1% paraformaldehyde solution, under ether-anesthesia. The tissues from the wall of lateral ventricles were fixed in the 2% osmium tetroxide solution. The results observed with electron microscope were as follow: 1. In 6 hours group, many ependymal cells were swelled, luminal portions of cytoplasms of some cells protruded into the ventricular lumen, and many cilia were lost or irregularly altered. 2. In 2 days group, ependymal cells were swelled more severely and subependymal edema were pronounced. 3. Protruded cytoplasm contained usually basal bodies of cilia, groups of mitochondria, endoplasmic reticula , etc. 4. Following X-irradiations, some protruded masses contained neural elements including the axon terminals with dense core vesicles. Axons and axon terminals were also found in the enlarged intercellular spaces among ependymal cells. From the above results, the heavy irradiation on the head area of the rat induced alteration of the ependymal cells lining the lateral ventricle. Hence the ependymal functions of selective barrier, protective barrier, and metabolic barrier could be altered following X-irradiation on the head.

서혜부 탈장교정술에서 Prolene Hernia System(PHS)교정술과 Total Extraperitoneal (TEP) 교정술의 단기 성적 비교

김지훈,장혁재,조휘동,김지훈,곽진호,한명식,최윤백 대한외과학회 2009 대한외과학회 학술대회 초록집 Vol.2009 No.11

Determination of Hepatitis B Immunoglobulin Infusion Interval Using Pharmacokinetic Half-life Simulation for Posttransplant Hepatitis B Prophylaxis

황신,송기원,정영규,안철수,김기훈,문덕복,하태용,정동환,박길춘,윤영인,조휘동,권재현,강상현,정이지,최진욱,이성규 대한의학회 2019 Journal of Korean medical science Vol.34 No.38

Background: Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. This study established an individualized HBV prophylaxis protocol, through optimization of hepatitis B immunoglobulin (HBIG) administration, with application of simulative half-life (SHL). Methods: This study involved five parts: Part 1 developed the SHL estimation method with 20 patients; Parts 2 and 3 assessed the SHL variability and developed a simulation model to apply SHL in 100 patients; Part 4 validated the simulation model in 114 patients, and Part 5 was a cross-sectional study on the current status of HBIG infusion intervals in 660 patients. Results: In Part 1, infusion of 10,000 IU HBIG induced add-on rise hepatitis B surface antibody (anti-HBs) titer of 5,252.5 ± 873.7 IU/L, which was 4.4% lower than actual measurement. Mean SHL of 20.0 ± 3.7 days was 2.2% longer than actual measurement. In Part 2, the medians of the intra- and inter-individual coefficient of variation in SHL were 13.5% and 18.5%, respectively. Pretransplant HBV DNA load and posttransplant antiviral therapy did not affect SHL. In Part 3, a simulation model was developed to determine the interval of HBIG infusion, by using SHL. In Part 4, all 114 patients were successfully managed with regular HBIG infusion intervals of ≥ 8 weeks, and the interval was prolonged to ≥ 12 weeks in 89.4%, with a target trough anti-HBs titer ≥ 200 IU/L. In Part 5, 47.4% of our patients received HBIG excessively, at a target trough titer of 500 IU/L. Conclusion: SHL estimation using only clinically available parameters seems to be reliably accurate when compared with actual measurements. We believe that SHL estimation is helpful to establish a personalized HBV prophylaxis protocol for optimizing HBIG administration.