Testicular Feminization Syndrome 의 1예

김현찬(HC Kim),정정완(JW Chung),손용석(YS Sohn),이준덕(JD Lee) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.5

임상적으로는 정상 여성이나 생식선은 난소대신 고환을 가진 testicular feminization syndrome의 1예를 보고하고 이에 대한 문헌적 고찰을 하였다. Testicular feminization syndrome or androgen insensitivity syndrome is one of the hereditary disorders in which the patient is genetic male yet shows phenotypic female because of a lack of specific cytoplasmic androgen receptor from intrauterine life. We have recently met such a case to report it as well as brief review of literatures.

악성난소종양의 임상병리학적 고찰

김현찬(HC Kim) 대한산부인과학회 1968 Obstetrics & Gynecology Science Vol.11 No.12

A Clinico-pathological survey was made on series of 93 malignat ovarian tumors, mainly operated upon at National Medical Center, Soul, Korean. The results obtained are as follows: 1) The incidence of malignant ovarian tumors of all ovarian tumors was 13.7% 2) Age distribution of malignant ovarian tumors was concentrated on the ages between 43-49(average 42 years). 3) The primary sterility rate and nulliparity rate of malignant overian tumors were 15.5% and 5.4%, respectively. 4) About 2/3(65.2%) of all malignant ovarian tumors had regular menstrual cycle and 34.7% of them had irregularity to some extent. Dysmenorrhea and menometrorrhagia were 15.1% and 10.4%, respectively. The later were all belonged to granulosa cell carecinoma. 5) As to the subjective symptoms of all malignant tumors, palpable mass in the lower abdomen, regardless the presence of ascites, was noticed in 86%, lower abdominal pain in 52.6%, G-I troubles in 24.7% and menstrual sisorder in 21, 5%. 6) Palpable masses were observed in 96.7%, ascites in 31.1%, anemic state in 15,0% and cachexia in 13,9%, in objective findings. 7) Cytological examination with vaginal or cervical discharge and ascites were positive in 3.7% and 54.1%(over Class III), respectively. The associated malignancy of endometrium was found in 8.3% of preoperative diagnostic curettage and surgical specimen. 8) The macroscopic and microscopic bilaterality were in 28.5% and 40%, respectively. 9) According to the International Clasification of the Clinical stage, Stage I in 32.2%, Stage II in 16.7%, Stage III 23.4%, Stage IV in 2.2% and Special category in 25.5%. 10)Regarding the macroscopic nature of the gross specimen, cystic variety was more common(55.7%). 12.0% of them were difficult to interpret its nature, whether benign or malignant. However, the cut surface revealed that the purely cystic tumors were only in 7.1%. 11)According to the Novak`s Histopathological Classification, serous cystadenocarcinoma was in 34%, pseudomucinous adenocarcinoma in 32%, granulosa cell tumor in 12.7%, primary solid carcinoma in 10%, teratoma in 4.2%, sarcoma in 2.8%, dysger-minoma in 1.4% and matastatic Krukenberg tumor in 2.8%. 12)Regarding the relationship between the clinical stage and histopathological type, the primary solid adenocarcinoma and serous cystadenocarcinoma seemed to be found in more advanced stage than pseudomucinous-cystadenocarcinoma. The granulosa cell tumor seemed to be proportionately distributed in all stages. 13)Treatment was surgical primarily and the principle of it was total or subtotal hysterectomy with bilateral salpingo-oophorectomy with or without omentomy. Adjuvant treatments, Thio Tepa and Co60 external irradiation, were applied to some of the operated cases. 14)Among the 43 cases, completely resectable at initial surgery, the sign of tumor within 1, 2 and 3 years were in 16.3%, 22.3% and 25.6% respectively. The effects of adjuvant treatment were hard to interpret but 7 cases responded to Co60 external irradiation more or less. 15)The 3 year survival rate was 36.3% of 33 operated cases and the presumed 5 year susvival rate seemed to be 26.3% of 19 operated cases.

임신중 난소종양의 임상적 고찰

김현찬(HC Kim),김순애(SA Kim),이명근(MK Lee),유석권(SK Yoo) 대한산부인과학회 1976 Obstetrics & Gynecology Science Vol.19 No.12

국립의료원 산부인과에서 1960년 1월초부터 1976년 7월말까지 경험한 임신중 난소종양 66예 에 대한 임상적 고찰을 하여 다음과 같은 결론을 얻었다. 1. 양성난소종양의 임신 및 분만에 대한 빈도는 각각 1:353, 1:312 이었으며 악성종양의 경우 는 각각 1:7771, 1:6546이었다. 2. 양성난소종양의 7.8%, 악성난소종양의 2.0%가 임신과 합병되었다. 3. 평균 연령은 30세이었으며 연령폭은 21-43세이었다. 4. 평균임신회수는 2.9회(1-21회) 평균 분만수는 1.8회(0-7회)이었다. 5. 병리조직학적 소견에서 양성낭성기형종이 제일 많아 32예(48.5%) 이었으며 장액성낭선종 10예(15.2%), 점액성낭선종 9예(13.6%) 단순낭종 5예(7.6%) 난포막황체낭종 4례(6.1%) 의 순위 이었고, 난소갑상선종, 양성간충조직종, 황체낭포가 각각 1례(1.5%)이었다. 악성종양 으로서 는 위암에서 전이한 Krunkenberg 종양, 장액성낭선암, 악성기형종이 각각 1례있었다. 6. 종양의 발생부위는 우측이 약간 많아 34례(51.5%) 좌측이 25례(37.9%)이었으며 7례(10.6%) 에서 양측성 이었으며 이중 4례의 양성낭성기형종, 2례의 난포막 황체낭종, 1례의 이차성 Krukneberg 종양이 있었다. 7. 초진시 주소, 증상 및 증후로는 하복통이 27례(40.9%)로 제일많았고, 부속기종양 18례 (27.3%), 질출혈 7례(10.6%) 압박증상 5례(7.6%) 하복보 불괘감과 진통이 각각 4례(6.1%) 위장 장애와 복부팽만이 각각 3예(4.5%) 의 순위었으며 증상 및 증후가 없었던 14례(21.2%)는 산 전관호시 진단되었다. 8. 총 66례중 50례(75.6%)에서 수술전 혹은 분만전에 정확히 진단되었다. 9. 임신초기에 30례(45.5%) 증기에 20예(30.3%) 말기 또는 만삭시에 12예(18.2%) 산욕기에 4 례(6%)수술을 시행하였다. 1. The incidence of benign tumors in pregnancy was 1 in 353 pregnancy and 312 delivery. Malignant tumors was 1 in 7771 pregnancy and 6546 delivery 2. Benign tumors complicating pregnancy was found in 7.8% among all operated benign tumors and the malignancy was in 2.0% among all malignant tumors operated. 3. Mean age was 30 years old and the range was 21-43 years old 4. Mean gravidity was 2.9 (1-21) and mean parity was 1.8 (0-7) 5. According to the histopatholgical type, benign cystic teratoma was found in 32cases (48.5%) serous cystadenoma in 10 cases (15.2%) mucinous cystadenoma in 9 caes (13.6%) simple cyst in 5 cases (7.6%) theca lutein cyst in 4 cases (6.1%) and 1 cases (1.5%) of struma ovarii benign mesenchymal tumor and corpus leteum cyst were found the malignant tumors were 1 case of metastatic krukenberg tumor serous cystadenocarcinoma and malignant teretoma. 6. The right side tumor was more common being 34 cases (51.5%) and the left was in 25 cases (37.9%) 4 cases of benign cystic teratoma 2 cases of theca lutein cyst and 1 case metastatic Krukenberg tumor were bilateral. 7. As to the initial chief complaints or the mode of presentation low abdominal pain was found in 27 cases (40.9%) adnexal mass in 18cases (27.3%) vaginal spotting or bleeding in 7 cases (10.6%) pressure symptoms in 5 cases (7.6%) abdominal discomrfort in 4 cases (6.1%) labor pain 4 cases (6.1%) gastroinitestinal troubles in 3 cases (4.5%) and abdominal distension in 3 cases (4.5%) etc. the fourteen cases (21.2%) free of symptoms or signs, were detected at anetnatal care. 8. Among the 66 cases 50 cases (75.6%) were correctly diagnosed before operation or delivery. 9. Thirty cases (45.5%) were operated in the first trimester, 20 cases (30.3%) in the second trimeseter 12 cases (18.2%) in the third trimester and 4 cases (6.01%) in the puerperium.

경계성 난소상피종양에 대한 임상적 고찰

김현찬(HC Kim),김기태(KT Kim),김우경(WK Kim),오희연(HY Oh),최영태(YT Choi),한지원(JW Han) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

A clinical and pathological study was made on a series of 34 cases of borderline epithelial ovarian tumors, which were managed at Pusan Paik Hospital of InJe university, from January 1985 to December 1996. The results obtained as follows: 1. The incidence was 19.9%(34/171 cases) among all epithelial ovarian malignancies. 2. Age distribution was between 14 and 78 years old, mean age was 37 years old. 3. As for the parity, nulliparity was most common(38.2%). 4. Abdominal discomfort(58.8%), palpable mass(41.2%) and abdominal distension(41.2 %) were the main symptoms. 5. As for the FIGO stage, 29(85%) cases were at Ia, 2(5.9%) cases at Ic, 1(2.9%) case at IIc, at IIIb, at IIIc, respectively. 6. The most common histological type was mucinous, 28(82.4%) cases, the next was serous, 5(14.7%) cases. 7. Among the surgical staging procedures, the positive rate of peritoneal cytology was 29 %(5/22) and that of omentectomy was 12.5%(2/16). 8. Twenty one(61.8%) cases were managed by conservative operation and 13(38.2%) by extirpative operation, and postoperative chemotherapy was given in 2 cases. 9. Follow-up was possible in 27(79.4%) cases. The duration of follow-up ranged from 7 to 115 months. Mean duration was 32.9 months. The presumed 5 year survival rate was over 85%.

약물에 의한 분만유도

김현찬(HC Kim) 대한산부인과학회 1978 Obstetrics & Gynecology Science Vol.21 No.5

분만유도에 관하여 간단한 고찰을 한 바 오늘날 여러가지 이유에서 분만유도의 빈도가 증가하고 있지만 효과적인 분만유도를 위해서는 제반 산과적, 의학적, 사회적 요인의 철저한 붖석 및 검토가 요구되며 이것을 기반으로 하여 경험이 있는 산과의에 의하여 적절히 시행되어야만 소기의 목적을 거둘 수 있다고 생각된다.

진행된 국소 자궁경부암에서 선행 항암요법의 효과

김용학(YH Kim),유병규(BK Yoo),김기태(KT Kim),김현찬(HC Kim) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.9

To evaluate the therapeutic potential of cytotoxic therapy in patients with cervical cancer, 57 previously untreated patients with bulky mass (more than 3 cm) in stage Ib, IIa, and IIb locally advanced cervical cancer were treated with three courses of induction chemotherapy of Cisplatin and 5-FU combined regimen and placed on subsequent radical surgery or radiation therapy during Jan. 1, 1988 to April 31, 1990. The results were obtained as follows. 1. As to the response rates, complete response was seen in 22 cases (38.6%), and partial response in 30 cases (52.6%), so the total response rate was 91.8%. 2. The rewponse rates seemed to increase in the lower clinical stage than the higher and the smaller size of the lesion than the bigger. 3. Thirteen cases of the 48 surgical specimens (27.1%) were found to be histologically free of disease. 4. The overall incidence of surgically documented nodal metastasis was found to be 29.1% and higher incidence was found in advanced clinical stage and poor responders. 5. Patients achieving complete response (CR) to induction chemotherapy with subsequent radical surgery had much more improved mean 2 year disease free survival rate compared with those who had radiation therapy after CR. 6. Toxicities encountered during chemotherapy were nausea and vomiting, alopecia, bone marrow depression, hepatotoxicity, nephrotoxicity, etc. and well tolerated in most of cases except one case of death due to severe bone marrow depression and septicemia. Conclusively, this preliminary study suggests that Cisplstin and 5-FU combination, followed by radical surgery is one of the most effective and beneficial treatment methods in the management of some patients who are at high risk for failure with conventional treatment. It is still necessary to take well designed prospective long term study with longer follow-up to define which modality of treatment could positively influence prolonged disease free survival.

쌍태임신에 관한 임상적 고찰

김성심(SS Kim),김현찬(HC Kim),배평원(PW Bae),김순애(SA Kim),박영주(YJ Park),박인재(IS Park),박찬무(CM Park) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.5

A clinical review of 239 twin deliveries at National Medical Center for 15 years from 1959 to 1973 was presented . 1. The frequency of twin birth was one in 71 births. 2. The youngest was twenty-one year old woman and the oldest was forty eight year old one in twin delivery, Average age was twenty-nine years. And in primipara 31.8 percent of twin delivery occured. 3. Delivery after 37th week of gestation occured in 76.5% and the babies weighting over 2500 gm. revealed 47.7% . And Apgar socre 7-10 was shown in 88% of the first twin and in 87.0% of the second. 4. In presentation cephalic presentation of the first twin revealed 75.8% and in approximately 70 % of vertex-breech combinations ,the first twin presented by the vertex. 5. Diagnosis of twin pregnancy before labor was made in 71.6% of 239 twin delivery 6. Sponaneous delivery of both babies occurred in 55.6% and operative delivery was performed in 44.4%. 7. Twenty four cases of cesarean section 10.0 % was encounted its main indication being such as repeat cesarean sections, fetal distress secondary inertia and eclampsia. 8. In 15.5% of the cases manual removal of the plaenta was perfomred. 9. About 1% of congenital anomaly was seen 10. Two cases of maternal deaths were encountered.

거대 난소낭종 1 예

최영태(YT Choi),안수현(SH Ahn),김영남(YN Kim),김우경(WK Kim),성문수(MS Sung),김기태(KT Kim),김현찬(HC Kim) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

A case of huge ovarian cyst in 30-year old woman is presented with a brief review of literature. This tumor was measured 60×60×30 cm in size, and weighed 75 kg. The pathologic diagnosis was mucinous cystadenoma, borderline malignancy, left ovary.

조산 위험도의 소급적 분석

김광원(KW Kim),최원배(WB Choi),한광수(KS Han),김현찬(HC Kim) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.6

Based upon the PREP scoring system, retrospective clinical analysis was attempted on 145 cases of spontaneous preterm delivery which had occurred during the period of 22 months from September, 1, 1982 to June, 30, 1984. The results obtained were followings: 1. The incidence of spontaneous premature delivery was 5.9% and early perinatal death was 35.2%. About two third(62.2)% of all perinatal death occurred in premature group. 2. The malority(92.4%) was belong to PREP score 11 or more and only 7.6% was in PREP score 10 or less. 3. The relationship between the last PREP score and newborn weight, and that of gestational weeks showed slight inversed tendency, respectively. 4. The predictable value of PREP score system seemed to be higher in primipara than multipara if the PREP score were under 20. 5. The relatively important constant risk factors were previous curettage, 2nd trimester abortion, preterm delivery, low socioeconomic state and short pregnancy interval. 6. The most important variable risk factors were uterine contraction and dilatation of cervix, and other factors were in order of unsuitable living quarters, poor weight gain, signs of preeclampsia, and anemia. 7. The causes of spontaneous preterm labor were in order of PROM(34.5%), unknown(24.1%), previous preterm delivery or late abortion (11.7%), faulty placentation (10.3%), and twin or hydramnios(7.6%).

지상아와 소두아를 동반한 쌍태임신의 1례

김성일(SI Kim),김현찬(HC Kim),임경모(KM Im) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.8

Fetus papyraceus is a rare complication of multiple pregnancy and microcephaly is a rare ano- maly of newborn. This report presents a case of monochorial twin pregnancy associated with fetus papyraceus and microcephaly, which was met recentlu at National Medical Center. The fetus papyraceus was female, 105mg in weight, 25cm in length, and seemed to be blighted at 6 months of pregnancy. Microcephalic baby was quite healthy until discharage and head diameters were 2-3 cm shorter than average.