거대자궁근종의 2 례

김영선(YS Kim),정지학(JH Jung),최원배(WB Choi),김영범(YB Kim) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.8

47세의 미산부 및 50세의 경산부에서 거대자궁근종을 경험하였기에 문헌고찰과 아울러 보고하는 바이다. Two cases of huge uterine myoma in 47 year old nulliparous waman and 50 year old multiparous waman were presented and brief review on literature was noticed.

자궁선근증에 대한 임상적 고찰

김영선(YS Kim),김성미(SM Kim),호삼수(SS Hoh) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.4

인천 길병원 산부인과에서 1981년 1월 1일부터 1984년 12월 31일까지 4년간 시행한 자궁적출술 715례중 자궁선근증 160례에 대하여 임상 및 병리학적으로 조사 분석하여 다음과 같은 결론을 얻었다 1 자궁선근증의 발생빈도는 22 5%였다 2 호발연령은 41-50세군이 55 6%로 가장 높았고, 평균연령은 43 7세였다 3 분만횟수는 3-5회군이 가장 많았고, 경산부가 96 2%를 차지하였다 4 육안적으로 임신 10주이상의 자궁비대는 64 4%였다 5 자궁선근증의 임상증상은 하복부 불쾌감 및 골반통(60 6%)이 가장 많았고, 월경과다(40 0%), 요통(39 4%), 월경통(18 1%)등의 순이었다 6 수술전 진단의 정확도는 6 9%로 임상증상만으로는 진단이 매우 어려웠다 7 합병질환은 만성골반염(33 1%)이 가장 많았고 자궁근종(23 1%), 정체낭종(9 4%)등의 순이었다 8 본 연구에서는 자궁내막증이 동반된 예는 관찰되지 않았다 9 자궁내막소견은 분비가 41 9%였고, 증식기는 27 5%였다 One hundred and sixty patients with adenomyosis were studied clinically and pathologically among 715 hysterectomized cases in the Department of Obstetrics and Gynecology, In Cheon Gil Hospital, during 4 years, from Jan 1 1981 to Dec 31 1984 The results obtained were summerized as follows; 1 Routine pathologic examination of the 715 hysterectomized uteri revealed adenomyosis in 160 specimens, an incidence of 22 5% 2 The highest incidence was 41 to 50 years of age group, an incidence of 55 6% and the mean age was 43 7 years 3 Adenomyosis was far more frequently observed in parous woman than non-parous woman, such as 96 2% and 3 8% respectively 4 Grossly, the size of the uterus was enlarged more than 10 weeks gestational size in adenomyosis, an incidence of 66 4% 5 Pelvic pain, menorrhagia, lumbago and dysmenorrhea were common symptoms of adenomyosis, and incidence of 60 6%, 40%, 39 4% and 18 1% respectively 6 Preoperative diagnostic accuracy for adenomyosis was 6 9% 7 Myoma uteri was the most common indication for operation, showing an incidence of 40 6% 8 Pelvic inflammatory disease and myoma uteri were common combined disease in the adenomysis, and incidence of 33 1% and 23 1% respectively 9 Endometriosis was not combined with adenomyosis in this study 10 Secretory phase of endometrium was the most frequent findings of adenomysis, an incidence of 41 9% and the proliferative phase was 27 5%

충양돌기 자궁내막증의 1예

김순애(SA Kim),김영선(YS Kim),이동훈(DH Lee) 대한산부인과학회 1964 Obstetrics & Gynecology Science Vol.7 No.2

23세의 기혼미임여자에서 타장기자궁내막증 합병없이 단독히 충양돌기에 발생한 자궁내막증의 1예를 보고한다.

선천적 선미부 기형종의 1예

이동훈(DH Lee),김영선(YS Kim),배혜진(HJ Bae),김정숙(JS Kim),옥숙미(SM OK) 대한산부인과학회 1966 Obstetrics & Gynecology Science Vol.9 No.8

The Authors Present a Case Report of Ruptured Corpus Luteum with intra-Abdominal Hemorrhage which they have Diagnosed as Rupture of Ectopic Pregnancy Before Operation.

견갑난산 78 예에 대한 보고

방재희(JH Bang),황옥민(OM Hwang),김영선(YS Kim) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.6

과거 10년간(1976∼1985) 일신기독병원에 입원하여 질식분만한 2 5kg이상 출생아 48,392예중 78예의 견갑난산을 경험하였으며 이를 분석 관찰하여 다음과 같은 결론을 얻었다 1 견갑난산의 발생빈도는 2 5kg이상 질식 두위분만 48,392예중 78예로 0 16%였고, 4kg이상 거대아 질식두위분만 1,893예중 40예로 20 1%였다 2 분만방법은 자연분만 44예(56 4%), 감자분만 22예(28 2%) 흡입분만 12예(15 4%)였다 3 산후 경구당부하검사를 시행한 31예중 13예에서 양성이 나타나 16%에 해당하였으며 이는 본병원의 과체중아에서 고혈당치를 나타낸 7 9%에 비해 높은 비율을 나타냈다 4 분만 2기의 연장은 초산부 30예중 1시간이상이 13예로 43 3%며 경산부 48예중 30분 이상이 20예로 41 6%에 해당했다 5 4kg이상의 거대아는 78예중 40예로 51 3%였으며 이는 동기간의 전체 발생율 2 1%에 비해 대단히 높은 비유을 나타냈고 임신주수 42주 이상인 과숙아는 22예로써 28 2%에 해당하며 이는 전체 과숙아빈도 9 4%에 비해 높은 비율을 나타냈다 6 신생아 측 합병증으로 저산소증 1분 Apgar 7점이하인 경우가 50예로 64 1%였으나 5분 Apga r7점이하인 경우는 9예로 12 9%였고 2예의 Erb`s Palsy 2예의 쇄골골절 1예에서 상완골절을 보였다 신생아 사망은 6예로 7 6%였으며 이중 2예는 저산소증(birth hypoxia)에 의한 경우였으나 나머지 4예는 선천성 기형아로서 태아수종 2예 무뇌아 1예 다발성기형아 1예였다 7 산모사망은 없었고 16예(20 5%)에서 500cc이상의 산후출혈이 있었으며 6예에서 수혈이 필요했다 8예(10 3%)에서 광범위한 질열상이 있었다 8 견갑난산의 적절한 처치로는 예견과 예방이 수반되어야 한다 거대아나 분만 2기의 지연이 견갑난산의 경계신호가 될 수 있으므로 모든 산과의사는 분만전에 태아의 크기를 잘 예측하여 4kg이상의 거대아로 예측될 때는 제왕절개술을 행함이 모체나 태아를 위해 안전하다고 사료된다 만약 예기치 못한 견갑난산에 당면한 경우 안전하게 응급처지를 할 수 있도록 산과의사들의 교육이 필요하다 Impaction of the fetal shoulders during vaginal delivery is a frightening and potentially lethal complication which requires immediate action but because of the rarity of this complication few individuals have had significant experience with it to act decisively This report presents the results of a retrospective study of 78 cases of shoulder dystocia among 48,392 vaginal deliveries at the Il Sin Christian Hospital, Pusan, from January 1976 to December 1985 The results were as follows 1 The incidence of shoulder dystocia was 0 16% in infants weighing over 2 5Kg delivered vaginally and 2 1% in infants weighing over 4Kg 2 Among the 78 delivereis there were 22(28 2%) forcep deliveries and 12(15 4%) vacuum deliveries 3 The incidence of abnormal early postpartum oral glucose tolerance test was 16% compared to only 7 9% in a study of large for gestational age infants at the same hospital 4 The second stage of labor lasted more than 1 hour in 13 of the 30 nullipare(43 3%) and more than half an hour in 20 of the 48 multipara(41 6%) 5 Fourty babies(51 3%) weighed more than 4000gm compared to an overall incidence of only 2 1% in vaginal deliveries during the same period and in 22 women(28 2%) the period of gestation was 42 weeks or more compared to an overall incidence of 9 4% 6 The Apgar score was 7 or less in 50 babies(64 1%) at 1 minute but at 5 minute the number was reuced to only 9 babies(12 9%) Considerable neonatal morbidity occured with 2 babies having Erb`s palsy, 2 fractured clavicle, and I fractured humerus There were 6 neonatal deaths 2 of which were due to birth hypoxia but the remaining 4 were due to congenital abnormalities, 2 cases of fetal hydrops 1 of anencephaly and 1 with multiple anomalies 7 There were no maternal deaths but 16 patients(20 5%) had a postpartum hemorrhage of 500ml or more and of these 6 required blood transfusion 8 patients(10 3%) had extensive lateral vaginal wall tears 8 Optimum management of shoulder dystocia involves anticipation and prevention

자궁내 태아사망의 임상적 고찰

이명희(MH Lee),오혜숙(HS Oh),김영선(YS Kim),김두호(DH Kim) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.2

Intrauterine fetal death is the death of a fetus after 20 weeks gestation or attainment of 500gm body weight prior to the complete expulsion from its mother. This is a clinical study of 159 cases of fetal death in uterus among 7650 deliveries at Incheon Gil Hospital during 4 years from January, 1980 to December, 1983. The results of this study are as follows: 1. The incidence of intrauterine fetal death was 2.07%. 2. Age distribution of mothers with intrauterine fetal death was between 18 to 41 years and was highest in the 26 to 30 years range(40.9%). 3. The parity of mother in intrauterine fetal death was most highest in nulliparous groups(54.7%) and next group is para-1. 4. There were 4 cases(2.5%) with previous history of intrauterine fetal death and 29 cases(18.2%) with previous history of spontaneous abortion. 5. The most common gestational weeks when intrauterine fetal death was detected was 37 to 40 weeks gestational period(21.4%) and the common presentation was cephlic(80.5%). The sex ratio of male vs female fetus was 1.01:1 and 69.2% of intrauterine fetal death weighing less than 2500gm. 6. The mode of delivery for intrauterine fetal death, spontaneous delivery was most common(40.8%), induction of labor was 33.5% and laparotomy was performed in 25.7% of intrauterine fetal death. 7. The etiologic factors of intrauterine fetal death, the unexplained cases were 37.8%, pre-eclampsia 19.5%, abruptio placenta 15.1%, congenital anomaly 6.3%, placenta previa 6.3%, syphilis 4.4%, chorioamnionitis 3.8%, cord prolapse 2.4%, maternal illness 1.8%, transverse lie 1.3%, trauma 1.3%. 8. There were 84 cases(53.8%) of maternal complication. The most common was hemorrhage(63.1%), and the others were intrapartum and postpartum fever (19%), cystitis(8.3%), wound infection(6%), uterine rupture(2.4%), sepsis(1.2%). 9. 77.9% of the cases had not received any prenatal care, 10.6% of cases had received care only 1 or 2 times and 3.3% had received 3 or 4 times, 8.2% had received more than 5 times.

임신중 혈액응고 장애에 관한 임상적 고찰

홍수명(SM Hong),윤정희(JH Yoon),윤숙희(SH Yoon),양석기(SK Yang),김영선(YS Kim) 대한산부인과학회 1984 Obstetrics & Gynecology Science Vol.27 No.1

1. 한 종류 이상의 혈액응고장애검사에서 비정상치를 보인 빈도를 보면 태바조기박리환자의 경우 72례중 47례(65%)로 가장 높았고, 그 다음 계류유산(21%)자궁내 타아사망(17%)의 순으로 나타났다. 2. 혈장 섬유소원농도와 섬유소원분해산물농도를 동시에 측정한 222례 중 두 검사 모두에서 비정상치 를 보인 빈도는 9.5%였으며, 섬유소원분해산물의 농도만 증가된 경우는 10.8%인 데 비해 저섬유소원혈 증만을 보인 것은 3.1%에 불과하였다. 실혈량이 2,000ml이상인 타반조기박리환자 25례를 분석한 결과 에서도 비슷한 양상을 나타내었다. 3. 태반조기박리의 경우 박리의 정도가 심할 수록 응고장애검사의 비정상치를 보이는 빈도가 증가하 였으며 실혈량도 많았다. 4. 태반조기박리, 자궁내 태아사망, 자궁내 태아사망, 계류유산의 경우 각 응고장애검사의 비정상치율 을 비교해 볼 때 응혈시간의 지연은 활성부분트룸보트프라스틴시간, 프로트룸빈시간, 섬유소원농도 및 섬유소원분해산물농도의 측정에 비해 현저히 낮은 비정상치율을 보였다. 5. 총 328례 중 육안적인 응고장애를 보인 경우는 3례였고, 이중 2례는 태반조기박리, 1례는 자간증 환자에서 관찰되었다. 이상의 결과를 요약하면 자궁내 태아사망이나 계류유산에 비해 태반조기박리 환자에서 현저히 높은 빈도의 비정상치율을 보였고, 혈장 섬유소원분해산물의 농도증가가 저섬유소원혈증에 비해 비교적 높은 빈도의 비정상치율을 보였을 뿐 아니라 범발성혈관내응고에 수반되는 출혈경향과도 밀접한 관련성이 있 음을 알 수 있었다. 임상에서 응고장애검사를 시행함에 있어 응혈시간의 측정외에 활성화부분트롬프라 스틴시간, 피로트롬빈시간 섬유소원농도 및 섬유소원분해산물농도의 측정이 반드시 필요하다고 생각된다. During the period September 1979 through to June 1981 328 women with complications of pregnancy in which blood coagulation defects could occur were admitted to Il Sin Women`s Hospital. The complications os pregnancy included 72 cases of abruptio placentae, 127 cases of intrauterine death, 66 cases of missed abortion and 63 other complications. The blood coagulation tests were clotting time, prothrombin time, activated partial thromboplastin time, platelet count and measurement of the plasma level of fibrinogen and fibrinogen degradation products. The resulte were as follows; 1. Of the 72 cases with abruptio placentae 65% showed abnormalities in more than one blood coagulation test compared to 21% and 17% in cases missed abortion and intrauterine fetal death respectively. 2. In 222 cases the plasma concentration of fibrinogen and fibrinogen degradation products were measured at the same time and 9.5% of them showed abnormalities in both tests. 10.8% showed an increase in the lebel of fibrinogen degradation, the higher the incidence of blood coagulation defects and the greater the amount of blood loss. 4. The percentage of patients showing a prolongation of clotting time was much lower than the percentage of patients with abnormalities of partial thromboplastion of coltting time was much lower than the percentage of patients with abnormalities of partial thromboplastion time, prothrombin time and plasma fibrinogen and fibrinogen degradation prolongation of clotting time was much lower than the percentage of patients with abnormalities of partial thromboplastion time, prothrombin time and plasma fibrinogen and fibrinogen degradation products. 5. only 3 of the total 328 cases had gross clinical blood coagulation defects and two of these were in patients with abruptio placentae, and the other was in a patient with eclampsia. In conclusion there was a hgher incidence of blood coagulation defects in cases of intrauterine fetal death and missed abortion. An increase in the concentration of plasma fibriogen degradation products was much more common than hypofibrinogenemia and these findings are consistent with suggestion that the increase of the fibrin degradation products may play the main role in bleeding tendency associated with disseminated intravasculr coagulation. This study has emphasised, that in addition to clotting time it is essential to do other tests, such as prothombin time, and plasma levels of fifibrinogen and fibrinogen degradation products, tn order to detect the coagulation defects that can accompany abruptio placentae, missed abortion and in trauterine fetal death.

양수과다증을 동반한 수두무뇌증 1 례

최원배(WB Choi),정지학(JH Jung),황인택(IT Hwang),김영선(YS Kim) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.3

37주 경산부 산모에서 양모 파수시 양수 과다증을 동반한 부검에서 수두무뇌증을 경험하였 기에 문헌적 고찰과 함께 보고하는 바이다. Hydranencephaly is an abnormality consisting of complete or almost absence of the cerbral hemispheres. This should be considered the end result of one of many destructive process in the cerebrum occuring during the prenatal peroid or the birth process or even postnatally. We report a case of Hydranencephaly in a new born female infant after 37 weeks gestaion from a 24 years old multipara woman who was uneventual during this pregnancy and its literatures and briefly reviewed

Testicular Feminization 증후 1예

장애숙(AS Chang),송혜섭(HS Song),강경화(KH Kang),양석기(SK Yang),김영선(YS Kim) 대한산부인과학회 1982 Obstetrics & Gynecology Science Vol.25 No.7

저자들은 본원에서 경험한 testicular feminization syndrome 1예를 보고하고 이에 대한 문헌적 고찰을 하였다. This paper describes a patient, thought to be female, who presented at age 20 for investigation of primary amenorrhea. She was found to be gentically male, with inguinal testes, but femine external genitalia. A diagnosis of male hermaphroditism with feminization was made. The relevent literature is reviewed.

선택적 Cyclooxygenase-2 억제제가 누드마우스에 이종이식한 인체 전립선암세포의 세포고사에 미치는 영향

오승령,신지현,안재호,노보상,안승현,김태형,명순철,김영선,방효원,이태진 大韓泌尿器科學會 2003 Korean Journal of Urology Vol.44 No.10