• Pediatric Infection and Vaccine
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• 제25권2호
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• pp.82-90
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• 2018

목적: 16년간단일기관에서시행된간이식후소아에서발생한세균감염합병증의빈도와특징을분석하기위해시행되었다. 방법: 2000년 1월부터 2015년 6월까지 서울대학교병원에서 간이식을 시행 받은 207명 소아 중 다장기 이식이나 2번 이상의 간이식을 시행 받은 18명을 제외한 189명이 연구에 포함되었다. 감염 증상과 더불어 병원체가 증명된 세균 감염 만을 대상으로 하여 감염성 질환의 종류 및 발생 시기 등을 조사하였다. 결과: 189명의 간이식 소아의 중간연령은 24개월(2개월-16세)이었으며, 수술 후 1년 간 추적 관찰 하였다. 총 87명(46.0%)에서 132건(0.7건/명)의 세균 감염이 발생하였다. 균혈증(n=39, 29.5%), 복막염(n=28, 21.2%), 요로감염(n=25, 18.9%), 폐렴(n=20,15.2%)의 순이었다. 그람양성균이 66건(50%), 그람음성균이 66건(50%)에서 확인되었다. 세균 감염은 이식 후 1개월 이내에 84건(63.6%), 1-6개월에 32건(24.2%), 6개월 이후에 16건(12.1%)으로 이식 초기에 유의하게 많았다(P<0.05). 가장 흔한 그람양성균은 Staphylococcus aureus (n=20, 15.2%) 와 Enterococcus species (n=20, 15.2%) 였으며, 그람음성균은 Klebsiella species (n=18, 13.6%), Enterobacter species (n=13, 9.8%), Escherichia coli (n=11, 8.3%) 순으로 많았다. 이 중 7명(41%)이 감염성 합병증으로 사망하였다(균혈증 4명, 복막염 1명, 폐렴 2명). 결론: 지난 16년 간 본 기관에서 소아에게 시행한 간이식 후 발생한 감염성 합병증의 빈도와 종류는 기존의 연구들과 비슷하였다. 간이식 후 소아에서 세균 감염 합병증은 이식 후 1개월 이내에 가장 많이 발생하며, 1개월이 지난 후에도 중증의 세균 감염으로 인한 사망률이 높아 6개월 전까지는 면밀한 세균 감염 합병증의 진단 및 치료가 필수적이다. 본 연구를 통해 향후 간이식의 예후 향상을 위한 연구의 토대가 될 것을 기대한다.

• Clinical and Experimental Pediatrics
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• 제49권10호
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• pp.1067-1072
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• 2006

목 적 : Alagille 증후군에 대하여 국내 증례 보고가 된 바 있으나 국내 Alagille 증후군 환자의 임상 양상에 대한 종합적인 분석은 없는 실정이다. 이에 국내 Alagille 증후군 환자의 임상양상과 장기 예후, 예후에 미치는 요인에 대해 알아보고자 한다. 방 법 : 1984년 7월부터 2006년 5월까지 서울대학교병원 소아과를 방문하여 Alagille 증후군으로 진단받은 30명의 환자를 대상으로, 만성 쓸개즙정체, 심혈관계 질환, 척추 이상, 눈의 이상, 특징적 얼굴형, 검사 결과, 예후를 기록지를 통하여 후향적으로 검토하였다. 결 과 : 만성 쓸개즙정체를 보인 환자가 100%, 심혈관계 이상이 있는 환자가 84.4%, 골격계 이상이 있는 경우가 30.0%, 안구의 이상이 있는 경우가 43.3%, 특징적 얼굴형을 보이는 경우가 100%였다. 30례의 환자 가운데 17례는 2세 경에 만성 쓸개즙정체가 호전되었고, 13례는 2세 이후에도 만성 쓸개즙정체가 지속되었다. 2세 경에도 만성 쓸개즙정체가 지속되는 환자는 합병증의 빈도가 유의하게 높았다(P=0.001). 30례의 환자 가운데 Alagille 증후군으로 인한 사망이 6례였고 이중 5례가 간질환의 합병증으로 사망하였다. 결 론 : Alagille 증후군 환자에서 간질환의 합병증이 사망의 중요한 원인이 되므로 이에 대한 주의 깊은 추적 관찰이 필요하며, 2세경에도 만성 쓸개즙정체가 호전되지 않는 경우 간이식을 요하거나 사망하는 빈도가 높으므로, 2세경에도 만성 쓸개즙정체가 지속되면 간이식을 고려해야 할 것이다.

• 대한영상의학회지
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• 제83권5호
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• pp.1014-1031
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• 2022

신생아 황달의 주요 원인인 담도폐쇄증은 Kasai portoenterostomy가 기본적인 치료 술식이다. 수술 이후 다양한 합병증이 발생할 수 있는데 portoenterostomy를 통해 발생하는 상행성 담도염이 가장 흔하다. 성공적인 Kasai portoenterostomy 후에도 간 섬유화가 진행할 수 있어 이로 인한 간경화, 문맥 고혈압으로 인한 합병증이 많은 경우에서 발생하게 된다. 합병증이 조절되지 않거나 진행성 고빌리루빈혈증이 있는 경우 간이식을 시행하게 된다. Kasai portoenterostomy 이후 합병증 확인 및 장기 생존 환자의 추적 검사로 다양한 영상 진단이 주요 역할을 하고 있다. 또한 간이식이 필요한 경우 이식 전후로 공여자 및 수혜자 모두에서 수술 금기 확인 및 합병증 조기 발견을 위해 영상 검사들이 중요한 역할을 한다. 초음파 검사가 추적 관찰에 가장 먼저 사용되는 유용한 검사이며 추가적으로 CT 및 MRI를 통해 진단에 도움을 받을 수 있다.

• 대한간호학회지
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• 제33권3호
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• pp.365-375
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• 2003

Purpose: This study was aimed to investigate the health related quality of life and related factors of organ transplant recipients. Method: The participants were 188 people who had liver(86), kidney(81), or heart(24) transplanted. Data on the demographic characteristics, transplantation-related characteristics, symptom frequency or discomfort measured by Transplant Symptom Frequency and Symptom Distress Scale by Lough et al(l987), and health related quality of life measured by SF-36(version 2) were collected. Result: Overall health related quality of life score was 492.1 for 100scoring and, 344.9 for norm based. Physical functioning showed the highest quality of life score (77.5) and vitality showed the lowest(51.l). The kidney transplanted showed the highest quality of life (504.4) and the heart transplanted showed the lowest(426.7) Quality of life was related with occupation(p=.016) and symtom discomfort(p < .0001). Conclusion: The health related quality of life of transplated patients was lower than the norm of American. Further studies need to be done to identify the norm of Korean and to investigate the effect of releving symptom discomfort on the increasing the health related quality of life.

• 성인간호학회지
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• 제24권3호
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• pp.284-293
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• 2012

Purpose: The aim of this study was to compare the levels of anxiety, depression, and quality of life (QOL) among kidney or liver transplant candidates and recipients. Methods: A cross-sectional descriptive design was utilized. The 160 subjects were recruited and assigned to three different conditions: awaiting transplant group; post-transplantation (TPL) group within less than one year of surgery; and post-TPL group with one year and no more than two years post surgery. The levels of anxiety and depression were measured by the Hospital Anxiety and Depression Scale. The level of quality of life was measured by the Medical Outcomes Study Short Form-36 version 2. Results: The anxiety score was significantly higher in the waiting group compared with the 1~2 years post TPL group. The depression score was significantly higher in the waiting group compared with the post TPL groups. The QOL was significantly lower in the waiting group compared with the post TPL groups. Conclusion: Our results show a high prevalence of anxiety and depression and a marked reduction in the QOL in transplant candidates compared to the recipients. This study indicates that the group waiting for transplants may have unmet needs during that time period. Health professionals should be encouraged to attend to the psychological distress of the transplant candidates in order to improve their quality of life.

• Journal of Chest Surgery
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• 제25권5호
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• pp.458-468
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• 1992

With the aid of extracorporeal circulation, nine dogs underwent orthotopic cardiopulmonary transplantation after preservation of the donor heart in a hypothermic amino acid[glutamate, aspartate] enriched high potassium extracellular solution, and preservation of the donor lung with hypothermic low potassium dextran solution from June 1990 to May 1991. The mean body weights of dogs were 20kg and the recipients` preoperative hematologic and hemodynamic pictures were within normal range except slightly decreased level of albumin and total protein, which was supposed to be due to malnutrition. The following modifications of the original Stanford technique were emphasized: [1] the posterior mediastinum is dissected as little as possible with meticulous hemostasis; [2] the surgical procedure is kept away from the phrenic and vagus nerves; [3] the tracheal anastomosis may be wrapped with recipient`s pulmonary artery flap or surrouding soft tissues. A combination of Cyclosporine, Azathioprine, corticosteroid was used as perioperative immunosuppressive therapy. Postoperatively all recipients could be weaned from extracorporeal circulation, showing favorable vital signs, but within 24 hours, irreversible congetive heart failure, ascites, arrhythmias developed with a mean survival time 13.6$\pm$6.6[n=9, range=6~26] hours. Hemoglobin and platelet counts were significantly[p<0.05] decreased postoperatively, which is thought to be attributed to blood damage by cardiopulmonary bypass and hemodilution. Postmortem finding included multiple subendocardial patch hemorrhage in both atrial and ventricular cavities, pulmonary and liver congestion, and all tracheal anastomoses were intact. Further consideration about quality control of the animal, infection, rejection, the effect of cardiopulmonary bypass on the experimental animal is required to improve the results.

• 한국발생생물학회지:발생과생식
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• 제23권2호
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• pp.79-92
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• 2019

Humanized mice, containing engrafted human cells and tissues, are emerging as an important in vivo platform for studying human diseases. Since the development of Nod scid gamma (NSG) mice bearing mutations in the IL-2 receptor gamma chain, many investigators have used NSG mice engrafted with human hematopoietic stem cells (HSCs) to generate functional human immune systems in vivo, results in high efficacy of human cell engraftment. The development of NSG mice has allowed significant advances to be made in studies on several human diseases, including cancer and graft-versus-host-disease (GVHD), and in regenerative medicine. Based on the human HSC transplantation, organ transplantation including thymus and liver in the renal capsule has been performed. Also, immune reconstruction of cells, of the lymphoid as well as myeloid lineages, has been partly accomplished. However, crosstalk between pluripotent stem cell derived therapeutic cells with human leukocyte antigen (HLA) mis/matched types and immune CD3 T cells have not been fully addressed. To overcome this hurdle, human major histocompatibility complex (MHC) molecules, not mouse MHC molecules, are required to generate functional T cells in a humanized mouse model. Here, we briefly summarize characteristics of the humanized mouse model, focusing on development of CD3 T cells with MHC molecules. We also highlight the necessity of the humanized mouse model for the treatment of various human diseases.

• Advances in Traditional Medicine
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• 제9권1호
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• pp.67-73
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• 2009

Temporary clamping of the portal triad is a common strategy to minimize bleeding during liver transplantation. Increasing evidences suggests that oxygen derived free radicals and reintroduction of oxygen in ischemic tissue lead to ischemic and reperfusion injury (I/R) and lead to apoptosis and necrosis. Adult Wistar rat subjected to 60 min of partial liver ischemia followed by three hour reperfusion. Eighteen Wister rats were divided into sham-operated control group (I) (n = 6), ischemia and reperfusion group (II) (n = 6), folic acid treated group (1 mg/kg body weight/daily by oral route for 7 days before induced ischemia reperfusion maneuver) (III) (n = 6). Apoptotic and necrotic hepatocytes, mitochondrial antioxidant enzymes were measured. Liver injury was assessed by alanine transaminases (ALT), aspartate transaminases (AST), liver histopathology and electron microscopy. An ischemic and reperfusion hepatocellular injury was indicated by increased serum-ALT, AST, histopathology and electron microscopy studies. Apoptotic and necrotic cells were increased which was revealed by flow cytometry in I/R group. Pre- treatment with folic acid significantly decreased serum -ALT, AST levels, apoptotic and necrotic cells after 1 h ischemia followed by 3 h of reperfusion. Histopathology and TEM studies showed markedly diminished hepatocellular injury in folic acid pretreated rats during the hepatic I/R, which reached a level comparable to saline-treated rat of sham operated group. On the basis of our findings it may be concluded that folic acid afforded significant protection from necrosis and apoptosis in I/R injury.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제4권1호
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• pp.113-119
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• 2001

소아에서 간의 간엽 과오종은 주로 복부팽만을 주소로 내원하여 대부분 2세 이내에 발견되며, 비교적 크기가 큰 낭종의 소견을 보이는 것으로 알려져 있다. 저자들은 담도 폐쇄증으로 Kasai 수술받은 8개월 여아에서 복부 초음파 검사상 작은 기질성 종괴를 우연히 발견하여 병리학적으로 확진된 간엽과오종 1례를 보고하는 바이다.

• Preventive Nutrition and Food Science
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• 제5권1호
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• pp.48-53
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• 2000

Inhibitory effects of the methanol extract, hexane extract, methanol soluble fraction (MSF) and juice from 3 weeks fermented Kimchi on the tumor formation in sarcoma-180 cell transplanted mice were studied. Effects of the solvent extracts and juice of the Kimchi on the levels of lipid peroxide, glutathione, and the enzyme activities of the liver were also investigated in normal and sarcoma-180 cell transplanted mice. At 32 days following trans-plantation, MSF reduced the tumor formation by 54% compared with the control group, resulting in the smallest tumor weight. Lipid peroxided content in liver increased by the transplantation of sarcoma-180 cells. However, it decreased when MSF of Kimchi was treated to the mice. MSF also suppressed xanthine oxidase activity in cytosol of the liver cells in mice transplanted by sarcoma-180 cells. Kimchi extracts had no inhibitory effect on hepatic aminopyrine-N-demethylase activity in sarcoma-180 cell transplanted or normal mice. Methanol extract and hexane extract of Kimchi slightly increased hepatic glutathione contents in sarcoma-180 treated mice. The injection of MSF from Kimchi markedly increased glutathione levels in the liver of sarcoma-180 treated mice. The injection of MSF from Kimchi markedly increased glutathione levels in the liver of sarcoma-180 treated mice compared to the controls. The MSF recovered the activities of hepatic glutathione reductase and glutathione S-transferase that decreased by the injection of sarcoma-180 cells. These results showed that MSF of Kimchi could suppress the growth of tumors, inhibiting lipid peroxide production and xanthine oxidase activity, in mice. We also suggested that Kimchi extract might play an important role in the prevention of cancer by enhancement of the glutathione level itself as well as via glutathione reductase and glutathione S-transferase.