항문직장기형 - 진단과 신생아기 처치 -

이남혁,Lee, Nam-Hyuk 대한소아외과학회 2006 소아외과 Vol.12 No.1

Anorectal malformations comprise a spectrum of disease and the majority of patients have one or more abnormalities that affect other systems. In evaluating a newborn with anorectal malformation, the decision regarding the need for a colostomy and detection and management of any life threatening associated anomalies are thetwo most important considerations. Perineal inspection provides the clue to the surgical approach in about 80-90 % of male and 90 % of female newborn baby. The remaining patients who do not show any clinical evidence need radiologic evaluation to decide whether a colostomy should be performed. In most cases the decision to make a colostomy should not be made until the baby is 20 to 24 hours old and evaluation to rule out the presence of associated anomalies completed. A divided colostomy at the junction of the descending and sigmoid colon is recommended for anorectal malformations.

작열통모델 흰쥐의 등쪽뿌리신경절 및 척수에서 α2-아드레날린 수용체 유전자발현의 변화

이남혁(Nam-Hyuk Lee),김동선(Dong-sun Kim),김정기(Jeong-Ki Kim),김광진(Kwang-Jin Kim),조희중(Hee-Jung Cho) 대한해부학회 1998 Anatomy & Cell Biology Vol.31 No.6

말초신경이 손상을 입었을 때 교감신경계가 어떠한 기전에 의하여 작열통을 유발시키는지 확실히 알려진 바는 없지만, 아마도 α-아드레날린 수용체 (α-adrenergic receptor, α-AR)를 매개로 하는 것으로 추측되고 있다. 본 연구에서는 정상흰쥐의 DRG 및 척수에서 α2A, α2B 및 α2C-AR mRNA의 분포를 in situ hybridization (ISH)기법으로 관찰하고 L5, 6 척수신경을 결찰한 작열통모델 흰쥐의 α2A, α2B 및 α2C-AR mRNA의 양적변화를 reverse transcriptase-polymerase chain reaction (RT-PCR) 법으로 관찰하여 다음의 결과들을 얻을 수 있었다. 1. 정상군의 ISH 결과, DRG의 작은, 중간 그리고 큰신경세포들에서 α2C-AR mRNA가 발현되었고 α2A-AR mRNA는 전체 신경세포의 16%에서 발현되었으며 주로 중간 및 큰세포에 분포하였다. 한편 α2B-AR mRNA의 발현은 관찰되지 않았다. 척수에서는 α2A-AR mRNA의 경우 등쪽뿔의 제 II, III층의 신경세포와 배쪽뿔의 운동신경세포에서 주로 관찰되었다. α2B-AR mRNA함유 신경세포는 관찰할 수 없었으며 α2C-AR mRNA는 배쪽뿔의 운동신경세포에서 주로 관찰되었다. 2. 결찰군에서 RT-PCR 결과, 결찰측의 L5, 6 DRG에서는 α2A-AR mRNA가 반대측 및 Sham군의 DRG의 그것에 비하여 유의하게 증가하였으며 α2C-AR mRNA의 경우 유의하게 감소하였다. L5 및 L6 척수의 결찰측은 반대측이나 Sham군의 척수에 비하여 α2A, α2B, 및 α2C-AR mRNA의 발현에는 유의한 차이를 발견할 수 없었다. 이상의 결과들에 의하면 DRG에 분포하는 α2A 및 α2C-AR는 말초신경 손상후 교감신경 의존성의 작열통 유발에 중요한 역할을 하며 척수의 α2-AR는 연관성이 없는 것으로 사료된다. While the pathophysiological mechanism by which sympathetic nervous system generates neuropathic pain is not clear, it is thought to involve an α-adrenergic receptor (AR). In the present experiment, we have elucidated the distribution of α2-AR subtypes mRNA in the DRG and spinal cord of normal rat with in situ hybridization (ISH) and analyzed changes in their expression in an experimental model of neuropathic pain with reverse transcriptase-polymerase chain reaction (RT-PCR). The results obtained were as follows; 1. The majority of small, medium and large DRG neurons of non-operated rats expressed α2C-AR mRNA. α2A-ARexpressing neurons were primarily medium-sized and large, comprising about 16% of the total neurons present. α2BAR-expressing neurons were not identified. In the spinal cord, α2A-AR mRNA were localized in neurons of lamina II and III, and large motor neurons in the ventral horn. α2C-AR mRNA was found in large motor neurons. 2. In the ligated animals, RT-PCR results showed that α2A-AR mRNA levels in L5, 6 DRGs on the ipsilateral side significantly increased compared to those of the contralateral sides and also to those of sham-operated rats. α2C-AR mRNA levels showed a marked decrease in ipsilateral L5, 6 DRGs. In the spinal cord, there was no detectable changes in α2A- and α2C-AR mRNAs levels. The present results indicate that α2A- and α2C-ARs in the DRG may play an important role in generating sympathetically maintained neuropathic pain and that α2-AR in the spinal cord seems not to be involved.

신생아의 미장낭종

이남혁(Nam-Hyuk Lee) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6

Tailgut cysts are rare congenital lesions thought to arise from vestiges of the tailgut/postanal gut, which is a primitive gut temporarily present at the most caudal portion of the embryo. The lesions are usually multilocular cysts lined by various types of epithelium in the retrorectal space. We experienced a tailgut cyst in an 18-day-old girl initially presented as an epidermoid cyst like skin lesion in the coccygeal region. MRI showed a well-defined multiloculated cystic mass between the rectum and coccyx, measuring 12×23 ㎜ and markedly hyperintense on T2 weighted images and hypointense on T1-weighted images. The cyst was surgically removed via a posterior sagittal approach and microscopically lined by ciliated columnar, transitional and squamous cells. Tailgut cysts are usually found in adult females, and extremely rarely in neonates. We report a tailgut cyst in a neonate with a review of the literature.

Hirschsprung씨 병에 대한 Modified Duhamel술식

이남혁(Nam Hyuk Lee),김상윤(Sang Youn Kim) 대한외과학회 1990 Annals of Surgical Treatment and Research Vol.39 No.4

BCG 림프절염의 외과적 치료

이남혁 ( Nam Hyuk Lee ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Background:Regional lymphadenitis is a common complication after BCG vaccination and has various clinical course, Various treatment, including medical, surgical, and combined are used to treat BCG lymphadenitis, but results are controversial. This study was performed to provide guidelines for surgical approach to BCG lymphadenitis. Materials and Methods:37 patients with BCG lymphadenitis at Yeungnam University Hospital between March 2004 and August 2007 were retrospectively reviewed. Suppurative BCG lymphadenitis were treated by surgical excision or incision and curettage. Non-suppurative BCG lymphadenitis were observed without any treatment and surgical treatment was applied when it became suppurative. Results:The mean age was 7.5 months(range 2-47 months) and most prevalent site of lesion was the ipsilateral axilla, Among 37 cases, 20 cases were already suppurative when diagnosed and 2 cases of 17 non-suppurative BCG lymphadenitis showed spontaneous resolution without any treatment, Surgery was performed successfully on 35 suppurative BCG lymphadenitis and postoperative complication was trivial. Conclusion:Suppurative BCG lymphadenitis were successfully treated with excision or incision and curettage without any serious complication, So non-suppurative BCG lymphadenitis can be observed expecting spontaneous resolution.

소아에서 고혈압, 번갈 다음증, 다뇨증, 및 저칼륨증을 유발한 레닌-분비성 윌름스 종양(Wilms' Tumor)

최영환,이남혁,김상윤,곽정식,Choi, Young-Whan,Lee, Nam-Hyuk,Kim, Sang-Youn,Kwak, Jung-Sik 대한소아외과학회 1997 소아외과 Vol.3 No.1

A 3-year-old boy with a Wilms' tumor had unusually severe hypertension, polydipsia, polyuria and hypokalemia. Physical examination on admission was unremarkable except for the presence of a smooth, firm mass in the right abdomen. Computerized tomography showed a tumor occupying the upper two thirds of the right kidney. Plasma renin activity and aldosterone concentration were markedly elevated, 37.7 mg/ml/hour(normal in supine position 0.15-2.33 mg/ml/hour) and 120.1 ng/dL(normal in supine position 1 to 16 ng/dL), respectively. Hypertension varied from 150/90 mmHg to 240/180 mmHg, and was not effectively controlled by antihypertensive drugs. Right nephrectomy was performed on the sixth hospital day. At laparatomy, there was no evidence of mechenical compression of the renal artery by the tumor. The tumor, about 8 cm in diameter, was confined to the renal capsule without involvement of the renal blood vessels at the hilum. Histopathology was Wilms' tumor of favorable histology. On electron microscopy, tumor cells contained intracytoplasmic electron dense secreting graules, suggesting the possibility of renin secreting tumor cells. Shortly after nephrectomy, signs and symptoms were relieved dramatically, and plasma renin activity and aldosterone concentration were also decreased to normal.

소아에서 서혜부탈장 수술 후 장골서혜신경 및 장골하복신경 차단술과 창상국소주사의 진통효과 비교

박대근,이남혁,Park, Dae-Geun,Lee, Nam-Hyuk 대한소아외과학회 2014 소아외과 Vol.20 No.1

The present study compared the postoperative analgesic effects of ilioinguinal and iliohypogastric nerve block with infiltration of local anesthetics (bupivacaine) into the wound in children after inguinal hernia repair. Ninety children below 7 years old who were scheduled elective inguinal hernia repair were randomly allocated into one of three groups. The patients in nerve block (NB) group, ilioinguinal and iliohypogastric nerve block was done with 0.5 mL/kg of 0.25% bupivacaine. The patients in infiltration of local anesthetics (LI) group, 0.5 mL/kg of 0.25% bupivacaine was infiltrated into the wound after surgery. The patients in control group were allocated as a Control group. Postoperative pain was assessed at 1, 3, 5, and 24 hours after operation with FLACC scale and additional analgesic consumption were counted. The three groups were not significantly different in age, sex, body weight, and duration of operation. Pain scores at 1 hour and 3 hours after operation were significantly higher in Control group than in NB group and LI group (p<0.01), whereas there were no difference between NB group and LI group. The rescue analgesics administration was significantly higher in Control group (n=11) than in NB group (n=6) and LI group (n=7) (p<0.05). There were 2 cases of transient femoral nerve palsy in NB group. Both of ilioinguinal and iliohypogastric nerve block and infiltration of local anesthetics into the wound provided effective postoperative analgesia in early postoperative period following inguinal hernia repair in children. But no difference between the two methods. Technically, infiltration of local anesthetics into the wound was easier and safer than ilioinguinal and iliohypogastric nerve block.

신생 여아에서 처녀막의 해부학적 구조와 외성기에 발생하는 기형

김태우,이남혁,김상윤,Kim, Tae-Woo,Lee, Nam-Hyuk,Kim, Sang-Youn 대한소아외과학회 1997 소아외과 Vol.3 No.2

The anatomical variations of the external genitalia including the hymen were observed prospectively in 1,500 female infants born between March, 1992 and July, 1992 at the Taegu Fatima Hospital. Careful inspection of the external genitalia was done within 24 hours after birth, and abnormal findings photographed. Almost all hymenal tissue appeared to be redundant. The hymen was annulus in 89.1 % of patients. Ninteen point nine percent had a central orifice and the remainder a ventral orifice. External ridges, intravaginal ridges, and clefts were present in 71.5 %, 50.7 % and 40.5 %, respectively. Congenital anomalies of the external genitalia were found in 20 patients(1.4 %). There were sixteen cases of hymenal cysts, two hymenal polyps, one imperforate hymen, and one Skene's duct cyst. Seven of the 16 hymenal cysts with stalks were excised and those without stalk were aspirated. Hymenal polyps were excised. Imperforate hymen was incised and drained, and Skene's duct cyst was aspirated successfully. The surgical procedure were done without anesthesia, and the results have been good. In conclusion, routine physical examination of the female newborn infant detects frequent developmental anomalies. The significance of those anomalies will be clarified after longitudinal long-term followup studies.

BCG 접종후 발생한 림프선염의 외과적 치료후 Isoniazid 투여의 필요여부

신관수,이남혁,김상윤,Shin, Kwan-Soo,Lee, Nam-Hyuk,Kim, Sang-Youn 대한소아외과학회 1997 소아외과 Vol.3 No.1

Regional lymphadenitis is the most common complication following BCG vaccination in this country. The literature describes controversial results with medical, surgical and combined therpy. The purpose of this study is to clarify the therapeutic effect of isoniazid(INH) after surgical procedures. The early and late postoperative complications of 136 children with lymphadenitis following BCG vaccination at the Taegu Fatima Hospital between March 1985 and February 1996 were reviewed. In 90 children, INH was given for 3-4 days before operation and for 3 months after surgery. In the other 46 cases, INH was not given during the pre- or postoperative period. Surgical procedures were excision or incision and currettage according to the states of lesions. Postoperative complications were fluid accumulation, wound infection, sinus formation and others. Complication rates were 14.4 % in INH-treated group and 13.0% of INH-nontreated group. The difference was not significant. There was no recurrence or other late complication in either groups. The result suggest that surgical excision or incision and currettage are sufficient for the treatment of regional lymphadenitis following BCG vaccination and postoperative INH therapy is not necessary.

소아에서 둔부 근육주사 후 발생한 국소 합병증

박두현,이남혁,김상윤,Park, Doo-Hyun,Lee, Nam-Hyuk,Kim, Sang-Youn 대한소아외과학회 1998 소아외과 Vol.4 No.2

Intramuscular injection(IM) into the gluteal muscles is a common route of medication, but may lead to complications. A retrospective review of 32 patients who required surgical treatment for local complications of buttock injections in children was made at the Taegu Fatima Hospital during a seven-year nine-month period (March 1990 to December 1997). Local complications included acute inflammation, cellulitis and abscess(71.9 %), and fat necrosis(21.9 %), and injection granuloma(6.2 %). Over the half of injections were on the upper and outer quadrant of the buttock, but the other 43.7 % were in the upper and inner or lower and outer quadrant which are considered unsuitable sites for intramuscular injection. The majority of complications developed within fat tissue(90.6 %) rather than within muscle(9.4 %). Two-thirds of the patients were under 2 years of age, this suggests that it is technically difficult to accurately administer IM injections in small children because muscle mass is smaller compared to subcutaneous. In addition subcutaneous fat is more susceptible to chemical irritation. Staph. aureus was the predominant organism, isolated in 84.6 % of the patients with abscesses. Treatment consisted of needle aspiration, incision and drainage, curettage, or surgical excision. In conclusion, the major factor that contributes to complications following IM of the buttock appears to be the inadvertent intrafat rather than of IM injection. Accurate injection into the muscles based on a knowledge of pelvic anatomy as well as the potential complications is necessary to prevent complications.