소아에서 완전 이식형 중심정맥포트를 위한 두정맥 절개술의 유용성

정규환,문석배,정성은,이성철,박귀원,Jung, Kyu-Whan,Moon, Suk-Bae,Jung, Sung-Eun,Lee, Seong-Cheol,Park, Kwi-Won 대한소아외과학회 2008 소아외과 Vol.14 No.1

The usefulness of totally implantable central venous port for long-term intravenous infusion is widely accepted in children. Usually the catheters are placed through the internal or external jugular vein. In case of jugular vein cut-down, two separate incisions are needed for catheter and port respectively. Patients also feel uncomfortable as the catheter run through the neck. However these disadvantages can be overcome by using the cephalic vein (CV). We reviewed our experiences on CV cut-down for totally implantable central venous port in children. From January 2002 to December 2006, 201 patients (M:F=127:74) underwent 218 central venous port insertions. Mean age at operation was 5.9 years (2 months - 19 years). Indications included chemotherapy (N=167), long-term intravenous antibiotics infusion (N=36), and total parenteral nutrition (N=15). CV was selected preferentially. The incision includes the deltopectoral triangle laterally, and both the CV cut-down and port insertion were achieved with a single incision. The number of insertion through external, internal jugular vein, and CV was 77, 66 and 75, respectively. The median age, height and body weight were higher in CV cut-down group. The youngest age for CV cut-down was 8 months, the shortest height was 69 cm and the smallest body weight was 5.9 kg. Of 118 trials of CV cut-down, cut-down was successful in 75 cases (63.6 %). CV was absent in 10 cases(8.4 %) and CV was sacrificed after catheter tip malposition in 10 cases (8.4 %). There was only one complication, in which the catheter was inserted into the minute branch of subclavian artery. The CV cut-down method for totally implantable central venous port was safe and feasible in selected groups of patients in children. In addition, preservation of jugular vein and a more favorable cosmetic effect are other benefits of CV cut-down.

Fitz-Hugh-Curtis Syndrome in A 15-year-old Adolescent with Right Upper Quadrant Abdominal Pain : Case Report

정규환,박태진,정성은,박귀원,김현영,Jung, Kyu-Whan,Park, Tae-Jin,Jung, Sung-Eun,Park, Kwi-Won,Kim, Hyun-Young Korean Association of Pediatric Surgeons 2011 소아외과 Vol.17 No.2

Fitz-Hugh-Curtis 증후군은 골반 내 염증성 질환을 가진 환자의 직접적 간 실질 침범이 없는 간피막 염증에 의한 간주위염으로, 1930년대에 Thomas Fitz-Hugh와 Arthur Curtis에 의해 보고되었다. Neisseria gonorrhea나 Chlamydia trachomatis에 의해 발병하며, 항생제로 치료되는 양성 성교전파질환이다. 대부분 가임기의 젊은 여성에서 발견되지만, 15세의 청소년에서 진단된 증례가 있어 보고하는 바이다. 15세 여자 환자가 1개월 전부터 발생한 간헐적인 우상복부와 하복부의 통증을 주소로 내원하였다. 환자는 한 달 전 남자친구와 첫 성교를 한 이후, 5일 전까지 10여 차례정도 성교를 하였다. 사회력 상 고등학교 1학년 생이고, 월경 주기는 28-30일로 규칙적이었다. 내원 당일 시행한 임신 반응 검사는 음성이었다. 시행한 복부전산화단층촬영에서 우측 간엽의 가쪽 부분이 동맥기 조영증강을 보이며 골반내감염을 동반하고 있었다. 부인과 검진 상 질경부 면봉 검사에서 Chlamydia trachomatis 양성소견을 보였으며, 소변배양검사에서 Neisseria gonorrhea가 동정되었다. Fitz-Hugh-Curtis 증후군 진단 하에 4주간 doxycycline과 metronidazole의 경구용 항생제 복용 후 호전되었다.

한국 아동학대의 현실

정규환 ( Kyu Whan Jung ),한호성 ( Ho Seong Han ),박도중 ( Do Joong Park ),은석찬 ( Seok Chan Eun ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

A trauma surgeon is always concerned about child abuse when he or she meets injured children. Abused children will be neglected if trauma surgeons only concentrate on the injured site or physical dynamics. Lately, violence on children has increased in Korea. Therefore, in this study, we considered child abuse through a review of the literatures. An eleven-year-old boy visited the emergency room vomiting with abdominal distension. He had been kicked in the abdomen by his step-mother 10 days earlier. The computed tomography revealed a transected pancreas tail and neck with a large pesudocyst (Fig. 1) and laboratory findings showed an elevated amylase level of more than 6,500 IU/L. Because he complained of severe pain with rebound tenderness on the whole abdomen, he underwent an emergent laparotomy, a distal pancreatectomy of the tail portion with an anti-leakage procedure on the cut surface of the pancreas. However, he underwent a distal pancreatectomy again on the neck portion of the pancreas because of a continuing pseudocyst with severe pain that could not be controlled with conservative managements. After that, his symptoms were improved and he returned to his daily life. (J Trauma Inj 2012;25:283-286)

복막투석 중인 소아에서 발생한 서혜부 탈장의 임상상

박희경,정규환,문석배,정성은,박귀원,Park, Hee-Kyung,Jung, Kyu-Whan,Moon, Suk-Bae,Jung, Sung-Eun,Park, Kwi-Won 대한소아외과학회 2009 소아외과 Vol.15 No.2

Peritoneal dialysis (PD) has been utilized for the children with end stage renal disease. Nevertheless, it is thought to promote inguinal hernia by increasing intraabdominal pressure. To investigate the clinical characteristics of inguinal hernia in children on PD, 155 cases of PD in children between January 1996 and June 2007 at Seoul National University Children's Hospital were reviewed retrospectively. Inguinal hernia developed in 16 cases (10.3 %, M:F=8:8). Hernia occurrence was not correlated to age. Eleven cases (69 %) of inguinal hernia developed in first 6 months after initiation of PD. All inguinal hernias were surgically repaired. No complications occurred related to inguinal hernia or surgery. Recurrent hernia developed in 1 patient (6.3 %) of 2 cases who had PD postoperatively on the day of surgery. In conclusion, inguinal hernia developed more frequently with children on PD than general population (3.5~5 %). The rate of hernia development was highest within the first 6 months following initiation of PD. After repair of hernia, we recommend to discontinue PD immediate postoperatively to prevent recurrence.

공기 정복술을 시행 받은 소아 장중첩증 환자들의 치료 결과 및 성공률에 영향을 미치는 요인

손일태,정규환,박태진,김현영,박귀원,정성은,Son, Il-Tae,Jung, Kyu-Whan,Park, Tae-Jin,Kim, Hyun-Young,Park, Kwi-Won,Jung, Sung-Eun 대한소아외과학회 2010 소아외과 Vol.16 No.2

Air reduction is a safe, effective, and fast initial treatment for pediatric intussusception. There is low dose radiation exposure. Factors affecting outcomes of air reduction were analyzed by reviewing the clinical features and results of treatment. A total of 399 out of 485 patients with pediatric intussusceptions were treated at the Seoul National University Children's Hospital from 1996 to 2009. All of the patients received air reduction as the first line of treatment. Clinical features such as gender, age, seasonal variation, symptoms, signs, types, pathologic leading point, and treatment results including success rate, complication, recurrence, NPO time, and duration of hospitalization were reviewed. The Pearson chi-square, student T-, and logistic regression tests were used for statistical analysis. P-value less than 0.05 was considered to be statistically significant. The prevalent clinical features were: male (65.4 %), under one-year of age (40.3 %), ileocolic type (71.9 %), abdominal pain (85.4 %), and accompanying mesentery lymph node enlargement (2.2 %). The overall success rate for air reduction was 78.4 % (313 of 399 patients), and the perforation rate during reduction was 1.5 %. There were 23 recurrent cases over 21.6 months. All were successfully treated with re-do air reduction. Reduction failures had longer overall NPO times (27.067hrs vs. 43.0588hrs; p=0.000) and hospitalization durations (1.738d vs. 6.975d; p=0.000) compared to the successful cases. The factors affecting success rates were fever (p=0.002), abdominal distension (p=0.000), lethargy (p=0.000) and symptom duration (p=0.000) on univariate analysis. Failure rates were higher in patients with symptom durations greater than 24 hours (p=0.023), and lethargy (p=0.003) on multivariate analysis. Air reduction showed high success rates and excellent treatment outcomes as the initial treatment for pediatric intussusception in this study. Symptom duration and lethargy were significantly associated with reduced success rates.

장 회전이상 환자에서 연령에 따른 임상적 특성의 차이

김종진,정규환,박태진,정성은,박귀원,Kim, Jong-Jin,Jung, Kyu-Whan,Park, Tae-Jin,Jung, Sung-Eun,Park, Kwi-Won 대한소아외과학회 2009 소아외과 Vol.15 No.2

Intestinal malrotation presents with different clinical characteristics, depending upon the age of the patient. The medical records of 44 patients treated for intestinal malrotation with/without midgut volvuls between January 2002 and August 2009 at Seoul National University Children's Hospital were reviewed retrospectively. Patients were grouped by the age criteria of 1 and 12 months. Fourteen patients were under 1 month of age (31.8 %), 9 patients between 1 month and 12 months (20.5 %) and 21 patients over 12 months (47.7 %). Twenty patients (45.5 %) presented with volvulus. Vomiting (66 %) and abdominal pain (20 %) were the most common symptoms. UGIS (68.2 %) was the most frequent diagnostic tool. Mean postoperative hospital stay was 13.7 days. There were 7 mild postoperative complications. Volvulus was more frequent in patients under 1 month (p=0.025) than over 1 month. The interval between diagnosis and operation was shorter in patients under 1 month (p=0.003) than in patients over one month of age. In the age between under and over 12 months, volvulus was more common in those under 12 months of age, but the difference was not significant. The interval from diagnosis to operation was shorter in patients under 12 months than over 12 months of age (p=0.001). Vomiting was the most frequent symptom in patients under 12 months. On the other hand, abdominal pain was the most frequent symptom in patients over 12 months. In conclusion, patients with intestinal malrotation had age-related differences in the presence of midgut volvulus, the interval between diagnosis and operation, and clinical symptoms. The age of the patient should be considered in order to determine adequate treatment of malrotation.

소아의 소장 중첩증의 치료 : 자연 정복 vs 수술적 치료

김은영,정규환,박태진,박귀원,정성은,김현영,Kim, Eun-Young,Jung, Kyu-Whan,Park, Tae-Jin,Park, Kwi-Won,Jung, Sung-Eun,Kim, Hyun-Young 대한소아외과학회 2010 소아외과 Vol.16 No.2

Unreduced small bowel intussusception requires operative treatment although the rate of spontaneous reduction is 60 to 70 %. The aim of this study is to compare clinical characteristics and outcome between spontaneous reduction and operation group and to analyze factors related to decisions to treat small bowel intussusceptions. The records of 25 patients with small bowel intussusceptions treated in Seoul National University Children's Hospital from January 1999 to August 2009 were reviewed respectively. Spontaneous reduction group (n=12, 48 %) had signs and symptoms of vomiting, abdominal pain, currant jelly stool, abdominal distension, fever, increased CRP but no rebound tenderness. One of them had been diagnosed with Henoch-Schonlein purpura and no one displayed pathologic leading point by image study. Operation group (n=13, 52 %) consisted of patients who had primary surgery. Their signs and symptoms were similar to spontaneous reduction group. Seven of them had underlying diseases such as Crohn' disease, ALL, Lymphoma, Peutz-Jeghers syndrome (n=3), post-transplanted state of liver and 2 of them displayed Peutz-Jeghers polyp and Meckel's diverticulum as pathologic leading point by preoperative ultrasonography. Mean relieve interval (interval between onset of symptoms and reduction/operation) was 1.78 days in spontaneous reduction group and 2.25 days in operation group (p=0.341). Seven of operation group had manual reduction and 6 out of 7 received segmental resection of the small bowel. No one of them underwent manual reduction and all of them underwent segmental resection were found to have pathologic leading points [Peutz-Jeghers polyp (n=3), Meckel's diverticulum (n=2), lymphoma (n=1)] during operation. In conclusion, 48% of small bowel intussusceptions resolved spontaneously. Patients' symptoms and relieve intervals were not related to the operative decisions. We therefore recommend significant factors for determining treatment plan such as change of clinical symptoms, underlying disease or pathologic leading point by imaging.

소아에서 시행된 췌십이지장절제술의 임상적 고찰

정진구,박태진,정규환,김현영,정성은,박귀원,Jung, Chin-Koo,Park, Tae-Jin,Jung, Kyu-Whan,Kim, Hyun-Young,Jung, Sung-Eun,Park, Kwi-Won 대한소아외과학회 2010 소아외과 Vol.16 No.1

Pancreaticoduodenectomy is the treatment of choice for adult periampullary lesions. However there has been no studies on the clinical outcomes of pancreaticoduodenectomy in children. To evaluate the clinical outcomes, records of 13 patients who underwent pancreaticoduodenectomy, from 1989 to 2009, at Seoul National University Children's Hospital were reviewed. Mean follow up period was 83 (2-204) months, the male to female ratio was 1:3.3, and the mean age was 11 (2-14) years. Ten patients underwent PPPD and 3 patients had Whipple's operation. The postoperative diagnosis included solid pseudopapillary tumor (9), cavernous hemangioma (1), pseudocyst (1), benign cyst (1), pancreatic disruption (1). Two patients developed postoperative adhesive ileus and among them one patient required operative intervention. Four patients required pancreatin supplementation due to steatorrhea and other gastrointestinal symptoms. There were no postoperative mortality during the follow up period and no evidence of recurrence in SPT patients. This study demonstrates that the pancreaticoduodenectomy procedure in children is not only feasible but also safe, with no mortality and an acceptable complication rate.

동굴외부 특성에 따른 유형 분류

신동원 ( Dong Won Shin ),정규환 ( Kyu Whan Jung ),조용호 ( Yong Ho Jo ) 한국동굴학회 2009 동굴 Vol.92 No.-

동굴의 유형 분류를 학술적 근거에 두지 않고 동굴 외부의 다양한 특성 즉, 숙박시설, 주변 관광지, 음식점수, 배후도시수를 변수를 이용하였다. 분석 기법으로는 군집분석을 이용하였다. 분석 결과 5개의 유형으로 분류되었으며, 이러한 결과는 관람객의 요구에 따른 다양한 분류가 가능하다는 결과를 말해준다. Classified by the characteristics of caves, without academic basis, was used by multiple variables of external characteristics of caves, such as accommodation, nearby attractions, number of restaurants & supporting cities. It used cluster analysis as an analysis technique. It is classified in 5 different typesby the results of the analysis, and the results say that the diverse classification of visitors` demand is possible.

개방동굴의 환경오염 사례연구

신동원 ( Dong Won Shin ),정규환 ( Kyu Whan Jung ),조용호 ( Yong Ho Cho ) 한국동굴학회 2008 동굴 Vol.87 No.-

동굴은 주요 관광자원으로 각광을 받으면서 개발되고, 일반인에게 개방되기에 이르렀다. 이러한 동굴들은 개방과 더불어 갖가지 환경오염 사례가 지적되고 있다. 본 연구는 이러한 동굴의 환경오염 사례를 밝히는데 목적을 두었으며, 그 결과는 다음과 같다. 동굴은 개발과 동시에 통로 개설에 따른 파손이 많이 이루어지고 있으며, 관람을 위한 각종 시설물에 의해 점차 오염되고 있다. 조명들과 같은 시설물은 빛을 제공해 줌으로서 녹색곰팡이와 흑색 곰팡이를 조성시키며, 관람객의 출입과 조명시설에 의한 동굴내부의 온도 상승은 건화현상과 박리 현상을 초래한다. 또한 관광객의 무질서한 행위에 의해 동굴내의 수질은 오염되고 동굴생물들의 설자리가 좁아지고 있는 실정이다. A cave starts to be destructed and damaged as soon as it`s open to the public. Due to many convenience facilities for tour visitors, it`s gradually polluted. For example, lamplight causes green and black mold while temperature rise caused by many tourists and lamplight brings vatting and exfoliation. In addition, visitors`reckless behavior have caused water pollution and destructed cave creatures` habitat.