• Journal of Chest Surgery
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• 제34권11호
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• pp.858-860
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• 2001

VATER 증후군은 심장의 기형을 동반하기 쉬운 복합기형이지만 적절하고 적극적인 수술적 치료에 의해 완치에 이를 수 있는 기형이다. 저자들은 VATER 증후군에 심장기형이 동반된 여아에서 적극적인 수술적 치료로 만족할만한 성과를 얻어 이 증례를 고찰과 함께 보고하는바이다.

• Advances in pediatric surgery
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• 제12권2호
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• pp.175-182
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• 2006

VATER association is defined as a combination of 3 or more anomalies- vertebra (V), imperforate anus (A), esophageal atresia with or without tracheoesophageal fistula (TE), renal and radial anomaly(R). We reviewed our experiences in one center to determine etiology, prevalence, clinical manifestation, other associated anomaly and prognosis. Two hundred and twenty-three cases that underwent operations for imperforate anus or esophageal atresia were analyzed retrospectively through medical records at Department of Pediatric Surgery, Asan Medical Center from June, 1989 to July, 2005. The total number of neonates who had been admitted during period of study were 46,773 and VATER association was 9 (0.019 %, 1.92 persons per 10,000 neonates). Median gestational age and birth weight were $37^{+4}wk$ ($35^{+1}$ - $41^{+4}$) and 2,594 g (1,671-3,660), respectively and median age of mother was 32 years (23-38). There was no family history. Three patients were twins but their counterparts had no anomalies. Patients who have 3 anomalies were 6, 4 anomalies in two and 5 anomalies in one patient. Vertebra anomalies were detected in 7(77.7 %), imperforate anus in 8(88.9 %), esophageal atresia in 5 patients (55.6 %), renal anomaly in 6(66.7 %), and radial anomaly in 5(55.6 %), respectively. Four patients are alive, 2 patients were lost during follow up period. Three patients died due to neonatal sepsis, respiratory dysfunction and cardiac failure. VATER association did not appear to be a definite risk factor, but merely a randomized combination of 5 anomalies. The prognosis was dependent on the other associated anomalies, appropriateness of management and operation. Careful follow-up and aggressive treatmentare required for improving survival and quality of life.

• 한국연극학
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• 제40호
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• pp.97-124
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• 2010

In Manpasikchok(die Welle $bes{\ddot{a}}nftigende$ und Friede stiftende $Zauberfl{\ddot{o}}te$) trift der Protagonist Chongsu im Traum seinen Vater, den er nach der Trennung $w{\ddot{a}}hrend$ des Koreakrieges nicht wiedergesehen hat. Sein Vater besucht das Grab seiner Mutter, die nach der Trennung 56 Jahre lang allein gelebt hatte. Die Vaterfigur in Manpasikchok, die Oh Taesok gestaltet hat, ist die Vater-Imago des Autors. Sein Vater ist $w{\ddot{a}}hrend$ des Krieges von den nordkoreanischen Soldaten nach Nordkorea geschleppt worden und kam nicht $zur{\ddot{u}}ck$. Manpasikchok ist ein Versuch, seinen Wunsch, mit seinem Vater, den er durch die Teilung Koreas nicht wieder sehen konnte, wiederzutreffen und endlich Friede zu $schlie{\ss}en$, auf der $B{\ddot{u}}hne$ zu verwirklichen. Die Vater-Imago in Manpasikchok bleibt aber nicht auf der bibliographischen Ebene, sondern erweitert sich zu einem Archetyp der nationalen Mythologie, indem sie mit dem Mythos Manpasikchok zusammengebunden wird. Dadurch wird das $St{\ddot{u}}ck$ zu einem Diskurs um die koreanische Wiedervereinigung erweitert. Oh ${\ddot{u}}berlegt$ sich in seinem $St{\ddot{u}}ck$ ${\ddot{u}}ber$ die $M{\ddot{o}}glichkeit$ des Zusammentreffens und der $Vers{\ddot{o}}hnung$ zwischen den $S{\ddot{u}}dund$ Nordkoreanern, die seit ${\ddot{u}}ber$ 50 Jahre lang in ganz anderem System gelebt haben. Das wird durch die Szene des Treffens des Protagonisten mit seinem Vater auf der $B{\ddot{u}}hne$ exemplarisch vorgezeigt. In Manpasikchok wird die Grundlage zur inneren Vereinigung vorbereitet. $Zun{\ddot{a}}chst$ wird aus der Sicht der Nordkoreaner die $s{\ddot{u}}dkoreanische$ Gesellschaft, die an Habgier verhaftet ist, kritisiert. Als Alternative dazu wird das Gewissen, das die Habgier korrigieren wird, vorgeschlagen. Durch die Dialoge der Nordkoreaner wird die Wichtigkeit der Kommunikation betont, die erst dann verwirklicht werden kann, wenn sich die $S{\ddot{u}}d$- und Nordkoreaner mit gegenseitigem Vertrauen treffen. Manpasikchok bietet eine $M{\ddot{o}}glichkeit$ der kulturellen Vereinigung, indem sich die Leute aus beiden Teilen Koreas trotz des Dialekts gut kommunizieren. $Dar{\ddot{u}}ber$ hinaus bindet Oh Taesok das Volksspiel aus Nordkorea Bukchong $L{\ddot{o}}wenspiel$ mit dem $s{\ddot{u}}dkoreanischen$ Puppenspiel zusammen und veranschaulicht die Vereinigung als eine Perfomance auf der $B{\ddot{u}}hne$.

• 한국간담췌외과학회지
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• 제27권1호
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• pp.107-113
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• 2023

Mixed adenoneuroendocrine carcinoma is defined as a tumor with a mixture of adenocarcinoma components and neuroendocrine neoplasm components. Each of these two components of mixed adenoneuroendocrine carcinoma accounts for at least 30% of all tumors. Mixed adenoneuroendocrine carcinoma might be located in the ampulla of Vater, a very rare location compared to other organs. Thus, its treatment and prognosis plans have not been established yet. We report three cases of mixed adenoneuroendocrine carcinoma occurring in the ampulla of Vater. Each patient had a different clinical course. In general, difficulty in preoperative diagnosis, risk of early recurrence, and poor disease course were main hallmarks of mixed adenoneuroendocrine carcinoma arising from the ampulla of Vater. However, one patient in this case report survived although she did not receive adjuvant chemotherapy due to her old age. Therefore, it is important to establish a careful treatment strategy for mixed adenoneuroendocrine carcinoma arising from the ampulla of Vater.

• 한국간담췌외과학회지
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• 제27권4호
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• pp.380-387
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• 2023

Backgrounds/Aims: In 2019, the grading and staging system for neuroendocrine neoplasms (NENs) was significantly changed. In this study, we report the clinicopathological characteristics and surgical outcomes of patients with extrahepatic biliary NENs who underwent curative resection with or without adjuvant treatment. Methods: We retrospectively reviewed a database of 16 patients who developed NENs, neuroendocrine carcinoma (NEC), and mixed endocrine non-endocrine neoplasms (MiNENs) after curative resection. Among them, eight patients had ampulla of Vater (AoV) tumors, and eight patients had non-AoV tumors. Results: G1 and G2 were more frequently observed in the AoV group than in the non-AoV group (12.5% and 62.5%, respectively). In contrast, NEC and MiNEN were more common in the non-AoV group (50.0%). High Ki-67 index (> 20%) and perineural invasion (PNI) were more frequently observed in the non-AoV group. Advanced age (> 65 years), mitotic count > 20 per 2 mm², and Ki-67 index > 20% were strongly correlated with patient survival (p = 0.018, 0.009, and 0.044, respectively). Advanced age (> 65 years) and mitotic count > 20 per 2 mm² were significantly correlated with disease recurrence (p = 0.033 and 0.010, respectively). Conclusions: AoV and non-AoV tumors had significant differences in the histologic grade, Ki67, and PNI. Patients with non-AoV tumors had an increased risk for survival and recurrence than those in the AoV group. For extrahepatic biliary NENs, early detection of tumors, adequate surgery, and aggressive adjuvant treatment for high-risk patients are important to achieve long-term survival and prevent disease recurrence.

• 한국간담췌외과학회지
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• 제26권2호
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• pp.138-143
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• 2022

Backgrounds/Aims: Pancreaticoduodenectomy (PD) is a standard surgical procedure for patients with periampullary cancer. During the follow-up period after PD, recurrence can be observed in various places with different prognosis. The aim of this study was to clarify the pattern of recurrence and factors affecting the survival of patients with periampullary cancer. Methods: Overall, 88 patients who received PD for distal common bile duct cancer or ampulla of Vater cancer were finally included and their clinical characteristics were analyzed. Patients were divided into three groups: recurrence-free (RF) group, an isolated locoregional recurrence (LR) group, and a distant metastasis (DM) group. Prognostic factors affecting recurrence in each group were analyzed and a survival analysis was performed. Results: Perineural invasion (PNI), T stage, and lymphovascular invasion (LVI) were significant risk factors for LR and PNI, lymph node metastasis, LVI, and T stage were associated with DM group compared to RF group in univariate analysis, respectively. N stage and PNI were significant risk factors (p = 0.046, p = 0.041) in overall survival of the LR and the DM groups. There was no significant difference in 5-year overall survival between the LR and DM groups. Conclusions: T stage was a significant risk factor of LR, while PNI was a significant risk factor of DM. There was no significant difference in overall survival depending on the site of recurrence.

• 한국간담췌외과학회지
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• 제28권1호
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• pp.114-114
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• 2024

• 대한가정학회지
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• 제31권4호
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• pp.53-66
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• 1993

Ausgangspunkt der Untersuchung ist der weltweite soziale Wandel der letzten Jahrzehnte und sein Einflu${\beta}$ auf die Entstehung und Charakteristiken junger Familien. Ein Ausdruck dieses generellen Wandels ist der Meinungswandel im Zusammenhang mit elterlichen Funktionen. Untersucht wurde, ob Rollenvorstellungen und die Beziehung der Eltern zueinander in einer bestimmten Phase des Familienlebens, n mlich w hrend des bergangs zur Elternschaft, unterworfen sind. Beurteilt wurden bergangseffekte im Vergleich von Ver nderungen bei Erst und Zweiteltern, die im Zusammenhang mit dem Baby aufgetreten sind. Dieses Vorgehen basierte auf der Annahme, da${\beta}$ bei Ersteltern st rkere Effekte auftreten als bei Zweiteltern. Die Ergebnisse basieren auf 130 s dkoreanishcen Erst-bzw. Zweiteltern die w hrend der Schwangerschaft(ca. 6 Monat) erstmals befragt wurden und auf verbliebenen 89 Elternpaaren, die sich an einer zweiten Befragung drei Monate nach der Geburt des Babys beteiligten. Die Ergebnisse der Untersuchungen haben gezeight, da${\beta}$ die koreanischen Erstv ter noch st rker als die Zweitv ter eine egalit re Elternrolle vor und nach der Geburt des Kindes bef rworten. Beim bergang zur Elternschaft kam es also nicht zu einer nderung in der traditionellen bzw. egalit ren Rolleneinstellung bei koreanischen Erst und Zweiteltern. Damit sind sowohl Ergebnisse zur Generativit t w hrend bei M ttern kein Unterschied erkennbar ist, zeigen sich die Erstv ter weniger konservativ als die Zwdeitv ter. Zusammenhang zwischen ehelicher Zufreidenheit und Partnerdifferenzen in Rolleneinstellungen wurde gefunden: Paare, bei denen die M tter st rker egalit r orientiert ist als die vater, besitzen niedrigere Werte in ehelicher Zufriedenheit.

• Advances in pediatric surgery
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• 제11권2호
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• pp.171-174
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• 2005

Chronic duodenal obstruction related to a congenital web is a rare anomaly, and is sometimes difficult to diagnose preoperatively. A case of partial duodenal obstruction by a foreign body in a 10-year-old girl with a congenital duodenal web is presented. She had a year history of intermittent epigastric discomfort without nausea, vomiting or growth retardation. Upper gastrointestinal series and gastroduodenoscopy disclosed a perforated web in the 2nd portion of the duodenum and a dark go stone just proximal to the web. The web was partly excised through a longitudinal duodenotomy crossing over the web. The Ampulla of Vater was located at 7 o'clock on the posterior surface of the duodenal web and was preserved. The duodenum was closed in transverse fashion. In cases of a longstanding duodenal foreign body, a congenital web should be considered.

• Advances in pediatric surgery
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• 제20권2호
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• pp.65-68
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• 2014

Congenital duodenal obstruction is a one of the emergent surgical conditions in neonates. Almost of them were diagnosed with double-bubble sign in prenatal ultrasonography. However, partial obstruction caused from duodenal web could be overlooked. We reported a duodenal web in early childhood. A three-year-old girl visited at our pediatric clinic for constipation. She had been showed non-bilious vomiting after weaning meal since 6 months old of her age, but her weight was relevant for 50-75 percentile of growth curve. Barium enema was initially checked, but any abnormal finding was not found. We noticed the severely distended stomach and 1st portion of duodenum. Upper gastrointestinal series revealed partial obstruction in 2nd portion of duodenum. After laparotomy, we found the transitional zone of duodenum and identified a duodenal web via duodenotomy. We performed duodeno-duodenostomy without any injury of ampulla of Vater. She was recovered uneventfully. During 6 months after operation, she does well without any gastrointestinal symptoms or signs, such as vomiting or constipation.