소아에서 둔상 후에 발생한 담도협착의 내시경적 치료 경험 1례

김경모,김성철,서동완,윤종현,Kim, Kyung-Mo,Kim, Seong-Chul,Seo, Dong-Wan,Yoon, Chong-Hyun 대한소아소화기영양학회 1998 Pediatric gastroenterology, hepatology & nutrition Vol.1 No.1

저자들은 복부 둔상 후에 발생한 담도 단독 협착을 보인 환아에서 수술적인 치료를 대신하여 내시경적 경비담도 배액술과 플라스틱 스텐트 삽입으로 증상의 호전과 2년의 추적관찰에서 재발을 보이지 않고 있는 1례를 경험하여 문헌고찰과 함께 보고하는 바이다. Isolated injury to the extrahepatic biliary tract following blunt abdominal trauma is rare, and there is little information especially in children regarding the endoscopic diagnosis and management of occult injury to the biliary tract. We experienced a 5-year-old boy who presented with jaundice 16 days after blunt abdominal trauma and was diagnosed as isolated distal common bile duct stricture by ultrasonography of abdomen. We could get more detailed information about the injury by endoscopic retrograde cholangiopancreatography. We could also manage this isolated common bile duct stricture successfully with endoscopic nasobiliary drainage and plastic stent insertion instead of surgical correction. There appeared to be no recurrence of stricture as evidenced by biochemical test and ultrasonography during 2 years of follow up.

신생아 담즙정체증의 원인질환 및 장기추적 예후인자에 관한 고찰

김경모,서정기,Kim, Kyung-Mo,Seo, Jeong-Kee 대한소아소화기영양학회 1999 Pediatric gastroenterology, hepatology & nutrition Vol.2 No.1

목 적: 신생아 담즙정체증은 소아과 소화기 영역에서 중요한 질환의 하나임에도 불구하고 원인 질환 및 장기추적 고찰에 대한 국내의 보고가 드문 실정이다. 따라서 저자들은 신생아 담즙정체증의 원인 및 추적조사시의 합병증 등의 임상적 고찰과 함께 예후인자를 분석하여 신생아 담즙정체증 환아의 진료에 도움을 주고자 본 연구를 시행하였다. 방 법: 1981년부터 1992년까지 12년간 신생아 혹은 초기 영아기에 발생한 담즙정체증으로 서울대학교 어린이병원 소아과에 입원하였던 190명을 대상으로 하였다. 담즙정체증의 원인질환, 추적조사시에 관찰된 합병증 및 사인, 특발성신생아간염과 담도폐쇄증의 초기의 임상적 차이점, 예후 및 예후 인자를 분석하였다. 결 과: 1) 담즙정체증의 원인질환은 190명에서 신생아 간염이 101례(53%), 간외담도계 질환이 84례(44%), 간내담도형성부전증이 5례(3%)이었다. 신생아간염은 특발성신생아간염이 77례(41%), 감염성 신생아 간염이 24례(12%)이었고, 간외담도질환은 담도폐쇄증이 79례(41%), 총수담관낭이 5례(3%)이었다. 2) 추적조사시에 관찰된 주요한 임상적 문제점은 지속적인 고열, 위장관출혈, 간성혼수, 복수 등이었다. 3) 담도폐쇄증 환아에서 지속적인 고열의 원인은 상행성담관염, 혹은 line-related sepsis가 58%이었고, 폐렴이 15%, 요로감염이 8%, 상기도 감염이 7%이었다. 4) 상행성담관염 혹은 line related sepsis의 원인균은 Escherichia coli가 28%로 가장 빈도가 많았고, Coagulase negative staphylococcus가 14%, Streptococcus pneumoniae, Klebsiela pneumoniae가 각각 10%, Enterococcus가 6%, Candida albicans가 4%이었다. 5) 주요한 사인은 간성혼수와 위장관출혈이었다. 6) 특발성신생아간염은 71%, 감염성 신생아간염은 75%의 환아에서 회복되었으며, 대부분 생후 12개월 이내, 주로 6개월 이내에 회복되었다. 미숙아, 초기의 간종대가 작은 경우, 초기 알부민치 높은 경우, 콜레스테롤치, ${\gamma}$-GT치, 빌리루빈치 및 AST치가 낮은 경우에서 예후가 양호하였다. 7) 담도폐쇄증 환아의 Kasai수술후의 5년 생존율은 40%이었고 사망의 대부분은 12개월 이내에 관찰되었다. 가장 중요한 예후인자는 수술시기이었고 수술시기가 12주 이전인 49%가 양호한 예후를 보인 반면에, 12주 이후인 경우는 12%이었다. 8) 담즙정체증의 초기 임상소견중 가장 중요한 예후인자는 원인질환이었다. 9) 특발성신생아간염과 담도폐쇄증 사이에서 차이를 보인 임상소견은 성별, 제태연령, 콜레스테롤 치 및 ${\gamma}$-GT치 이었다. 특발성신생아간염은 남아, 미숙아에서 호발하였고, 낮은 콜레스테롤치 및 ${\gamma}$-GT치를 보였다. 결 론: 우리나라에서 신생아 담즙정체증의 흔한 원인으로는 담도폐쇄증과 특발성신생아간염의 빈도가 가장 높았고, 이외에 감염성 신생아 간염, 총수담관낭, Alagille 증후군 등이었으며, 유전성, 대사성질환은 관찰되지 않았다. 신생아 담즙정체증에서 원인질환은 예후를 결정하는 가장 중요한 요인으로 원인질환에 대한 적절한 진단이 요구되며, 또한 상행성 담관염, 폐렴, 패혈증 등의 감염문제, 간성혼수, 위장관 출혈 등은 장기 추적시의 자주 발생하는 심각한 임상적 문제점으로서 이에 대한 적절한 치료대책이 요구된다고 하겠다. Purpose: The aim of the present study was to evaluate the long-term clinical profile including the underlying etioligy and the prognostic factors of the neonatal cholestasis. Method: We studied the 190 infants presented with neonatal cholestasis for the last 12 years (from 1981 to 1992). The underlying causes, clinical findings and long-term outcomes were evaluated. And the prognostic factors were also analyzed. Result: Underlying disease were neonatal hepatitis in 101 (idiopathic in 77 and infectious in 24), intrahepatic bile duct paucity in 5, biliary atresia in 79, choledochal cyst in 5. Metabolic disease was not observed in this study. The important clinical problems during follow-up were persistent high fever, gastrointestinal bleeding, hepatic encephalopathy and ascites. The main causes of the death were hepatic encephalopathy and gastrointestinal bleeding. While three fourth of infants with idiopathic and infectious neonatal hepatitis recovered usually within a year, five-year survival rate for biliary atresia was just 40%, the mortality observed usually within the first year after Kasai operation and prognostic factor was the time of operation. Underlying disease was the most important prognostic factor of neonatal cholestasis. Conclusion: This study showed that most common causes of neonatal cholestasis were biliary atresia and idiopathic neonatal hepatitis, infectious neonatal hepatitis, choledochal cyst and Alagille syndrome, but few neonatal cholestasis of genetic or metabolic liver disease was observed. The most important long-term prognostic factor of neonatal cholestasis was the underlying disease.

소아 간이식

김경모,Kim, Kyung Mo 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.8

소아에서 간기능 검사 이상 소견의 해석과 실제

김경모,Kim, Kyung Mo 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.suppl1

The causes of liver disease in children and abnormal liver function test are more diverse than those in adult. Therefore, the first step to evaluate the liver disease is the understanding the liver disease and interpreting the appropriate liver function test in children. The characteristics of each test and various conditions which we encounter in outpatients settings will be discussed in this article, especially focused on elevation of aminotransferase level without identifiable causes.

소아청소년 염증성 장질환의 치료

김경모,Kim, Kyung Mo 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.suppl2

The incidence of inflammatory bowel disease is increasing rapidly in Korea and one quarter of the new patients present in childhood. Crohn's disease and ulcerative colitis are incurable conditions associated with significant morbidity, therefore the focus of treatment in children should be to reduce or eliminate symptoms, optimize nutritional status and growth, prevent complications. This review will deal with the evidence supporting the treatments currently used in children with inflammatory bowel disease.

소아 간이식의 현재

김경모,Kim, Kyung-Mo 대한소아소화기영양학회 2007 Pediatric gastroenterology, hepatology & nutrition Vol.10 No.1

Outcome of liver transplantation for children with end liver disease has been improved markedly during last two decades. Improvement of immunosuppressive agent and its strategy to use in children, development of innovative surgical technique, and better understanding of the course of liver transplantation attributed to better outcome of pediatric liver transplantation. Therefore this review article will focus on the problems which can occur during pre- and post-transplantation period, current strategy to use immunosuppressive agent for the better understanding of pediatrician who is not involved in transplantation but takes care of the children pre- and postoperatively.

박판 성형 공정에서 스프링백의 강건 설계

김경모(Kyung-Mo Kim),인정제(Jeong-Je Yin) 한국기계가공학회 2013 한국기계가공학회지 Vol.12 No.2

Springback is a very typical dimensional discrepancy phenomenon, which occurs usually on the final stamping parts after the tool loading is removed. Variation of springback leads to amplified variations and problems during assembly of the stamped components, in turn, resulting in quality issues. The variations in the properties of the incoming material and process parameters are the main causes of springback variation. In this research, a robust design methodology which combines orthogonal array based experimental design and design space reduction skim to reduce the springback variation for advanced high strength steel parts in sheet metal forming is suggested. The concept of design space reduction is adapted in the experimental design setup to improve the quality of the obtained solution. The effectiveness of the proposed procedures is illustrated through a robust design of springback in metal forming process of a cross member of auto body.

이용자 협업형 뉴스제작의 참여 결정요인: 합리적 행동 모형과 동기 분석의 통합적 접근

김경모 ( Kyung Mo Kim ),김나래 ( Na Rae Kim ) 한국지역언론학회 2013 언론과학연구 Vol.13 No.4

개방-소통-공유의 웹2.0 환경에서 일단의 아마추어 시민기자가 상호작용적 미디어 이용행동으로서 협력적 뉴스제작에 나서면서 온라인 공간에 새로운 참여 저널리즘 공동체를 형성하고 있다. 이용자 협업형 뉴스 사이트의 활성화는 시민기자의 개방적 참여와 자율적 협력에 좌우된다. 이 연구는 협력적 뉴스제작에 참여하는 아마추어 시민기자의 뉴스협업 현상을 이해하고자 뉴스협업 행동과 결정요인의 관계를 탐색했다. 합리적 행동 모형과 동기 분석에 기초해 <위키트리>의 시민기자를 설문조사한 결과는 다양한 동기, 태도와 규범, 뉴스제작 경험이 협업의도와 협업행동, 뉴스유형별(경성 vs 연성) 협업행동에 각각 상이한 영향을 미친다는 것을 보여준다. 특히, 뉴스 협업행동에 이르는 사회심리학 기제가 뉴스유형에 따라 다르게 작동한다는 점을 확인할 수 있었다. 분석결과를 토대로 아마추어 뉴스 이용자의 협력적 뉴스제작 활동이 온라인 저널리즘에 제기하는 함의를 토론했다. As amateur citizen-journalists engage in collaborative news making on interactive news sites in the web 2.0 environment, a new online participatory journalismcommunity is forming. The effectiveness of user collaborative news sites depends on the involved citizen-journalists`` open participation and voluntary collaboration. In order to understand news collaboration initiated by a variety of amateur citizen-journalists, this research explored the relationships between social psychological determinants and collaborative news production. The survey results of citizen-journalists of Wikitree, a user collaborative news site in Korea, revealed that various motivations, attitudes and subjective normexplained user collaborative intention and behavior, respectively. Past experiences in news production, however, failed to predict news collaboration, contradictory to a theoretical expectation. Also, the results suggested that social psychological mechanism underlying news collaboration among citizen-journalists may be differentiated whether it is for producing hard news or soft news. Finally, the implications of user collaborative news activities for online journalismwere discussed.

2속성 강건 설계를 이용한 박판성형공정의 최적화

김경모(Kyung-Mo Kim),인정제(Jeong-Je Yin),박종천(Jong-Cheon Park) 한국기계가공학회 2014 한국기계가공학회지 Vol.13 No.2

Fractures and wrinkles are two major defects frequently found in the sheet metal forming process. The process has several noise factors that cannot be ignored when determining the optimal process conditions. Therefore, without any countermeasures against noise, attempts to reduce defects through optimal design methods have often led to failure. In this study, a new and robust design methodology that can reduce the possibility of formation of fractures and wrinkles is presented using decision-making theory. A two-attribute value function is presented to form the design metric for the sheet metal forming process. A modified complex method is adopted to isolate the optimal robust design variables. One of the major limitations of the traditional robust design methodology, which is based on an orthogonal array experiment, is that the values of the optimal design variables have to coincide with one of the experimental levels. As this restriction is eliminated in the complex method, a better solution can be expected. The procedure of the proposed method is illustrated through a robust design of the sheet metal forming process of a side member of an automobile body.

Mahalanobis Taguchi System을 이용한 사출 공정의 최적설계

김경모(Kyung-Mo Kim),박종천(Jong-Cheon Park) 한국기계가공학회 2017 한국기계가공학회지 Vol.16 No.1

Warpage is a major defect frequently found in the injection molding process, and the reduction of warpage is a very challenging problem because of the uncontrollable factors, such as variations in the process parameters. Without any countermeasure against these noises, attempts to reduce the defects often lead to failure. In this research, a new robust design methodology, based on the Mahalanobis Taguchi System (MTS) to reduce warpage, is presented. The MTS performs the orthogonal array experiments and uses the signal-to-noise (SN) ratio of the Mahalanobis distance as a performance metric. The validity of the proposed method is illustrated through an optimal design of the injection molding process of a CPU base plate.