산부인과 영역수술후 감염증 예방에 있어서의 ornidazole 의 투여효과

이승훈(SH Lee),한상균(SK Han),김장흡(JH Kim),나종구(JG Na),김수평(SP Kim),이헌영(HY Lee) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.3

1987년 5월1일부터 1987년 8월31일까지 4개월간 가톨릭의과대학 부속성모병원에 수술을 받 기 위하여 입원한 환자중 무작위로 추출한 50명을 대상으로 수술후 감염방법을 위하여 ornidazole 단회 투여법으로 얻은 임상결과에서 다음과 같은 결론을 얻었다. 1. 수술후 부작용은 창상감염 및 농양 2예, 자궁내막염 2예, 발열 2예, 요로감염 1예, 기관지 감염 1예등 8예에서 발생하여 16%의 발생율을 보였다. 2. 창상감염 1예와 자궁내막염 1예는 혐기성 및 호기성균 복합감염이었으며 나머지 6예는 모두 호기성균 감염이었다. 3. 수술후 협기성균 감염에 ornidazole 은 96%의 예방효과를 보였고, 혐기성 균주로는 2예에 서 모두 peptostreptococci가 배양되었다. 4. 호기셩균 감염은 ornidazole 단독 투여군에서 3예, ornidazole 과 cephradine동시 투여군에 서 5예가 발생했다. 5. ornidazole 투여에 다른 부작용은 전혀 없었다. The aim of this study was to investigate the effect of ornidazole (a(chloromethryl)-2-methy-5-nitroimidazole-1-ethanol;Tiberal), administered prophylactically against postoperative infections connection with Obsterics and Gynecology surgery. 50 patients aged between 23 and 62 years who had to undergo abdominal surgery at the Department of Obsterics and Gynecology, Catholic University Medical College from May 1987 to August 1987 were admitted to the study. 25 patients in group A were given at the time of premedication 1 hour before the start of the operation, 1000 mg ornidazole in 500 ml 5% dextrose in water by intravenous infusion. 25 patients in group B were given 1000 mg ornidazole in 500ml 5% dextrose in water by hour before the start of the operation. The two medications were administered seperatively in group B cases The results obtained were as follows; 1. Postoperative complications occured in 8 cases (16%); 2 with wound abscess, 2 with endometritis, 2 with fever , 1 with urinary tract infection and 1 with pneumonia. 2. 1 case with wound abscess and 1 case with endometriosis were combined anaerobic and aerobic infections and the other 6 cases were all aerobic infections. 3. There was 95% prophylactic value of ornidazole in preventing anaerobic infections postoperatively, 2 strains of peptostreptococi were isolated from the infectious foci. 4. 3 aerobic infections were observed in group A compared to 5 in group B. 5. No side effects attributable to the ornidazole administered were observed . The study demonstrates that ornidazole is effective in preventing anaerobic infections postoperatively, But does not prevent complications with aerobic pathogens. So the neccessity of giving adjuvant prophylaxis against aerobic infections must also be emphasized.

Ritodrine 이 신생아 혈당값에 미치는 영향

노덕영(DY Ro),이충훈(CH Lee),이종건(CK Lee),나종구(JG Na),김수평(SP Kim),이헌영(HY Lee),성인경(IK Sung),이병철(BC Lee),조성훈(SH Cho) 대한산부인과학회 1988 Obstetrics & Gynecology Science Vol.31 No.11

저자들은 ritodrine이 신생아 탄수화물 대사에 미치는 영향을 알아보고져 ritodrine주입을 받은 모성에서 태어난 신생아 40예를 실험군으로 그리고 ritodrine주입이 없었던 모성에서 태어난 신생아 18예를 대조군으로하여 다음과 같은 결론은 얻었다. 1. 실험군과 대조군간에는 성비, 임신주수, 신생아체중, 1분, 5분 Apgar score, 분만통의 유 무, 제왕절개술 빈도에서 유의한 차이가 없었다. 2. 혈당값은 실험군에서 37.9±2.4 ml/dl 대조군에서 63.1±13.0 ml/dl 로 두군간에는 통계적으 로 유의한 차이가 없었다. 3. 저혈당증의 발생빈도는 실험군 40예중에서 9예 대조군 18예중 2예에서 발생하여 두 군간 에는 P value 0.06으로 통계적으로 유의성은 없었다. 그러나 저혈당의 임상증상을 보인 3예 는 모두 실험군에서 발생하였다. 4. 실험군 혈당값중에서 질식분만 예들은 43.3±4.8 mg/dl, 분만통을 갖고 제왕절개술한 예들 에서 36.3±15.0 mg/dl 분만통없이 제왕절개술한 예들에서 35.9±2.7 mg/dl엿으며 각군간에 혈당값은 유의한 차이가 없었다. In order to assess the effect of ritodrine on neonatal carbohydrate metabolism the sugar levels of the neonate delivery by ritodrine treated women were compared with those of the neonate delivery by non-treated women The results were as follows; 1. There was no significantly difference in sex ratio, gesational age, birth weight 1-minute and 5-minute Apgar score the presence of labor and the number of cesarean section delivery between these two groups. 2. The sugar levels were 37.9±2.4 mg/dl in experimental group and 63.1±13 mg/dl in control group . But there was no significantly difference 3. The hypoglycemia occured in 9 of 40 cases of experimental group and 2 of 18 cases of control group , respectively. But there was no significantly difference. All of the symptomatic hypoglycemic cases (3cases) occured in the experimental group . 4. In the experimental group , the blood sugar levels of vaginal delivery group , cesarean section with labor group and cesarean section without labor group were 43.3±4.8 mg/dl, 36.3±15.0 mg/dl and 35.9±2.7 mg/dl ,respectively. There was no significantly difference in each other.

미숙분만에 관한 임상통계학적 관찰

이상대(SD Lee),김영일(YI Kim),노영숙(YS Roh),김수평(SP Kim),나종구(JG Na),김승조(SJ Kim) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.7

1975년 1월부터 1984년 12월까지 만 10년간 가톨릭의과대학 부속 8개병원(성모병원, 강남성모병원, 성바오로병원, 성가병원, 성빈센트병원, 대전성모병원, 부평성모자애병원 및 의정부 성모병원) 산부인과에서 분만한 총 98739예의 분만중 미숙분만 6434예에 대한 통계학적 분석을 시도함으로서 미숙분만을 일으킬수 있는 여러위험 인자들에 대한 빈도를 조사하여 다음과 같은 결론을 얻었다 1 산모의 연령분포는 전체분만에 대한 미숙분만의 비율이 20세 이하 11 1%, 35세이상 9 9%로서 21-34세군의 6 2%에 비해 현저히 높았다 2 산모의 분만횟수에 따른 미숙분만은 분만횟수가 증가할수록 미숙분만예도 점차 증가되어 초산부 6 1%부터 5회이상 경산부 23 7%까지 증가되었다 3 산모의 유산횟수와 미숙분만과의 관련성은 유산경험이 없는 경우 5 5%부터 4회이상의 유산 20 7%까지 유산횟수가 증가됨에 따라 미숙분만예도 점차 증가 되었다 4 신생아 체중 및 임신 주수와의 관련성은 임신 28주 이전, 신생아 체중 1500gm이하인 경우는 대부분 사망하였고, 특히 신생아 사망율은 임신주수와 관련성이 깊었다 5 분만 과거력상 조산기왕력이 있는 경우 전체 분만예에 비해 미숙분만예가 33배, 사산기왕력과 자궁수술 기왕력의 경우 2배로 높아 관계가 깊었으나 과거 제왕절개 수술력은 별 관련성이 없었다 6 기타 위험인자로서는 융모양막염, 전치태반, 태반조리박리, 쌍태임신등이 미숙분만과 관련이 깊었다 7 지역간 미숙아 사망율의 비교시에서는 도시지역의 미숙아 사망율 감소가 농촌지역의 사망율 감소 추세보다 크게 나타났다 The preterm birth has recently become one of the most important issues in obstetrics The development of neonatology has made a great contribution to the treatment of preterm baby and decrease of neonatal mortality rate In order to investigate the various risk factors of preterm birth and contribute to prevention of preterm birth hereafter, we performed statistical analysis on 6434 cases of preterm birth delivered at Department of Obstetrics and Gynecology, Catholic Medical College from 1975 to 1984 The results were obtained as follows 1 The rate of preterm birth to total birth by maternal age was 11 1% in maternal age of under 20years and 9 9% in maternal age of over 35 years, and these were significantly higher than 6 2% in maternal age of 21-34years 2 Number of preterm birth was increased as number of delivery was increased, and preterm birth rate was increased from 6 1% in nullipara to 23 7% in multipara over 5 deliveries 3 Number of preterm birth was increased as number of abortion was increased, and preterm birth rate was increased from 5 5% in the group experienced no abortion to 20 7% in the group experienced abortion over 4 times 4 Most of newborn babies with under 28 weeks of gestational age and under 1500gm of body weight were expired and neonatal mortality is closely related to gestational age 5 As compared with total births, preterm birth was shown 33 times more in cases with previous preterm birth and 2 times more in cases with previous FDIU and previous uterine operation Therefore preterm birth is closely related to previous obstetrical history, but not related to previous cesarean section 6 Other obstetrical risk factors like chorioamnionitis, placenta previa, abruptio placenta and multiple pregnancy were also related to preterm birth 7 Neonatal mortality rate was decreased more significantly in urban area when compared with that in rural area

분만유도 목적으로 사용한 PGE2질정의 효과

한구택(GT Han),최승도(SD Choi),이진우(JW Lee),나종구(JG Na),김진홍(CH Kim),김수평(SP Kim),이헌영(HY Lee) 대한산부인과학회 1985 Obstetrics & Gynecology Science Vol.28 No.3

The mechanism of the initiation of labor is not yet fully understood, but it is generally believed that some factors such as the changes of the endogenous steroid hormones and the prostaglandin may be responsible for the cervical ripening and myometrial contraction. Nowadays the prostaglandin has been used through various routes to induce labor. In order to clarify the effects of prostaglandin of the labor induction and the mechanism of labor, the PGE2 was administered intravaginally to the 42 pregnant women between 38 and 42 weeks gestation and the levels of estradiol, progesterone and cortisol were measured by RIA from the serum collected before and during labor and after the placental expulsion. The results were as follows; 1. The failure rate of the induced labor by intravaginal PGE2 was 9.5%. 2. The mean durations of labor of the control and the experimental group were 4.27±2.38 hours and 4.10±2.67 hours respectively. 3. There were no significant differences between the Apgar scores of the newborn infants delivered from the control and experimental those from the group. 4. The level of the estradiol of the control and experimental group with successful results measured before labor were 32.1±6.2ng/ml and 38.8±12.1ng/ml respectively, and those measured after placental expulsion were 27.3±4.3ng/ml and 20.6±12.5ng/ml respectively. There was significant decreases in the estradiol levels after labor compared with those before labor. 5. The levels of progesterone of the control and the experimental group with successful results measured before labor were 221.2±58.7ng/ml and 245.8±62.9ng/ml respectively, and those measured after placental expulsion were 170.0±49.6ng/ml and 161.0±76.4ng/ml respectively. There were significant decreases in the progesterone levels after labor compared with those before labor. 6. The levels of cortisol of the control and the experimental group with successful results measured before labor were 33.9±7.0㎍/dl and 40.9±9.8㎍/dl, and those measured after placental expulsion were 63.4±10.2㎍/dl and 69.9±15.4㎍/dl respectively. There were significant increases in the cortisol level before labor compared with those before labor. We conclude that the changes of the endogenous steroid hormones in the women intravaginally administered PGE2 were similar to those in control group and the intravaginal admistration of PGE2 may be the effective method for induction of labor.

철분공급이 임신부와 태아의 혈청 Ferritin헤모글로빈 , 혈청철 및 철결합능에 미치는 영향

정은숙(ES Jung),송기창(KC Song),정운남(WN Jung),나덕진(DJ Rah),김대훈(DH Kim),나종구(JG Na) 대한산부인과학회 1989 Obstetrics & Gynecology Science Vol.32 No.7

1987년 10월부터 1988년 2월까지 5개월간 가톨릭의과대학 부속병원에서 정상분만한 임신부 54명과 그에게서 출생한 정상신생아 54명에서 혈청 ferritin, 혈색소, 혈청 철, 총 철결합능을 측정하여 다음과 같은 결론은 얻었다. 1. 임신부의 혈청 ferritin치는 평균 23.7+-21.7 ug/l, 혈색소치는 평균 11.4+-1.8g/dl, 혈청 철은 평균 121.0+-80.0ug/dl이고 총 철결합능은 평균 446.9+-133.9ug/dl이엇다. 이들에서 출생한 태 아의 제대혈의 혈청 ferritin치는 평균 118.0+-62.1ug/dl이고, 총 철결합능은 평균 289.9+-86.3ug/dl이었다. 임신부와 제대혈의 검사치를 비교하면 혈청 ferritin, 혈색소, 혈청철은 모두 제대혈에서 5배, 1.3배, 1.6배로 높았다. 2. 임신부의 ferritin치에 따라 구분해보면, ferritin치가 12ug/l이상인 군은 31명(58%)이고 그미 만인 군은 23명(42%)으로 임신부의 혈청 ferritin치와 제대혈청 ferritin치사이에는 유의한 상관 관계가 있었다. 그러나 임신부의 혈청 ferritin치와 제대혈의 혈색소치, 혈청 철사이에는 상관 관계가 없었다. 3. 임신부의 혈색소치를 기준으로 혈색소치가 11g/dl이상인 군과 그 미만인군으로 나누어 비 교해 보면 임신부의 혈색소치와 제대혈의 혈색소치, 혈청과 혈청 ferritin사이에 유의한 상관 관계가 없었다. 4. 철분공급에 따른 차이를 보면 철분공급을 받은 경우에 임신부와 제대혈에서 모두 혈청 ferritin의 상승을 보였으나 제대혈의 혈색소치와 혈청철에는 유의한 차이가 없었다. 5. 임신부의 연령, 임신회수, 임신주수와 태아체중에 따른 철분대사 기준의 변화는 없었다. Measurements of serum ferritin and other hematologic laboratory indices about iron metabolic state were done in 54 paired maternal and cord blood, and 17 of these 54 women had taken iron supplement during pregnancy. These values were analyzed by parameter of maternal serum ferritin hemoglobin, iron supplement, and following results were obtaiend. 1. Average value of maternal serum ferritin was 23.7+-21.6 ug/l and that of hemoglobin was 11.4+-1.8 g/dl and those for serum iron and TIBC were 121.0+-80.0 ug/dl and 446.9+-133.9 ug/dl respectively 2. Values of cord serum ferritin hemoglobin serum iron were higher than maternal values especially cord serum ferritin was about 5 times higher than maternal serum ferritin 3. There was linear correlation between maternal serum ferritin and cord ferritin . But there was no correlation between maternal serum ferritin and cord ferritin hemoglobin serum iron and TIBC. 4. There was no correlation between maternal hemoglobin and cord hemoglobin serum iron and serum ferritin. 5. By iron supllement, the average values of maternal hemoglobin , maternal ferritin and cord serum ferritin were increased. 6. Iron hematologic indices were not changeable by maternal age, parity gestational week and fetal weight.

절박유산 및 자간전증 환자의 혈청내 순환면역 복합체의 관한 연구

오경추(KC Oh),이상대(SD Lee),심도진(DJ Shim),김영일(YI Kim),김진홍(CH Kim),김수평(SP Kim),나종구(JG Na) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.12

1985년 1월부터 1985년 12월까지 가톨릭의대 부속 강남성모병원 산부인과에 내원하였던 정상임부 60명, 절박유산 환자 10명, 자간전증환자 10명을 대상으로 혈청면혁 복합체치를 C1q binding assay로 측정하여 다음과 같은 결론을 얻었다 1 정상임부의 혈청 C1q binding %는 임신 제 1기 11 77±4 65, 제2기 11 93±6 26, 제3기 16 69±12 02로써 임신후반기에는 증가하는 경향을 보였으나 의의있는 차이는 보이지 않았다 2 절박유산 환자의 C1q binding %는 임신 제1기와 비교할 때 약간 높게 나타났으나 유의한 차이는 없었다 3 자간전증 환자의 C1q binding %와 임신 제3기의 C1q binding %간에는 유의한 차이가 없었다 4 절박유산 환자의 예후에 따른 C1q binding %는 유산이 일어난군과 임신이 계속된군 사이에 유의한 차이가 없었다 Under the hypothesis that immune mechanism is related to incidence of threatened abortion and preeclampsia, in order to comfirm the role of immune complex as a causing factor of its clinical symptoms, we measued circulating immune complexexs in patients of threatened abortion and preeclampsia by PEG (polyethylene glycol) precipitation method by using complement C1q and obtained the following results 1 Serum C1q binding % of normal pregnancy was 11 77±4 65 in 1st trimester, 11 93±6 26 in 2nd trimester and 16 69±12 02 in 3rd trimester, and tended to increase in 3rd trimester But significant difference was not shown 2 Serum C1q binding % of threatened abotion showed slight increase when compared with 1st trimester of normal pregnancy 3 No significant difference of C1q binding % was found between preeclampsia and 3rd trimester of normal pregnancy 4 No significant difference of C1q binding % according to prognosis in patients of threatened abortion was found between abortion group and term pregnancy group

유식세포 분석기를 이용한 부인암 환자의 T세포 측정 : 초기 및 화학요법후 T세포 아형 Initial and Postchemotherapy State of T-lymphocyte Subset

이헌영,나종구,김세일,유기성,정난주,신진웅,이경숙,노정숙 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.2

부인암 환자에서 면역능 저하상태를 측정하고, 면역능 저하가 항암 화학요법의 부작용에 미치는 영향을 알아보고자 24명의 부인암 환자와 10명의 정상여성에서 유식세포 분석기를 이용하여 T세포 아형을 측정하였다. 또 항암 화학요법이 면역기능에 주는 영향과 화학요법의 부작용과의 관계를 밝히기 위해 17명의 부인암 환자에서 항암 화학요법 전과 48시간후에 T세포아형을 측정하여 다음과 같은 결과를 얻었다. 1. 임파구 수는 정상 여성에서 2422.0±236, 부인암 환자에서 1708.7±187.7로 부인암 환자에서 유의하게 감소하였다(P=0.038). 2. Th수, Ts수, Th/Ts비는 정상 여성과 부인암 환자 사이에 유의한 차이가 없었다(P$gt;0.05). 3. 항암 화학요법 전 그리고 48시간 후에 측정한 임파구 수는 화학요법 전이 1752.5±239.2, 후가 1358.1±174.7로 유의한 감소를 보였으며(P=0. 028), Ts수도 화학요법 전이 500.5±76.0, 후가 382.0±67.7로 유의한 감소를 보였다(P=0.029). 4. 항암 화학요법 전과 48시간 후에 측정한 Th수와 Th/Ts비는 유의한 차이가 없었다(P$gt;0.05). 5. 초기 Th/Ts 비가 낮은 환자는 항암 화학요법의 부작용이 심하게 나타났으며(P=0.045), 화학요법후 Th/Ts비가 낮은 환자에서도 항암 화학요법의 부작용은 심하였다(P=0.028). 6. 항암 화학요법후 Th수가 40%이상 감소한 환자(n=5)는 40%미만 감소한 환자(n=5)보다 화학요법의 부작용이 심하였다(P=0.035). 이상의 결과로 볼 때 부인암 환자에서 암 자체에 의한 면역기능의 저하가 있으며, 화학요법에 의해 면역기능은 더욱 저하되며, 면역기능 저하와 화학요법의 부작용과 유의한 연관성이 있었으며, 단일 클론 항체를 이용하여 유식세포기로 측정한 T세포 아형은 부인암 환자의 면역기능 측정 및 화학요법의 부작용 예측에 유용한 검사법임을 확인하였다. Depression of peripheral blood T-cell number and in vitro reactivity have been observed in cancer patients and cancer chemotherapeutic agents have immunosuppressive side effects. Combining the specificity of monoclonal antibody with developed technology has helped modern flow cytometry have a jajor impact in clinical evaluation of the immune status. To investigate the immune suppression of the patients with gynecologic malignancy and to predict the side effect of chemotherapy, flow cytometric analysis of T-lymphocyte subpopulations was done in 24 patients with gynecologic malignancy at initial stage and 17 patients among them at 48 hours after chemotherapy. Control group was composed of 10 healthy woman aged from 31 to 51. The results were as follows ; 1. Total lymphocytes count was 1708.7±187.7 in patients and 242.2±236 in control group, and there was significant decrease in patients compared to control group(p=0.038). 2. There was no significant difference of the number of T helper (Th) and T suppressor (Ts) and the Th/Ts ratio between patients and control group. 3. Total lymphocytes and Ts count were significantly decreased after chemotherapy (p$lt;0.03), but Th count and Th/Ts ratio were showed no significant difference. 4. The patients had low Th/Ts ratio before or after chemoterapy showed severe side effect by Zubroad performance status scale (p$lt;0.05). 5. The severe side effect was seen in the patients showed decrease of Th count over 40% than in the patients under 40% decrease after chemotherapy (p=0.035).

자궁내막의 Mullerian Adenosarcoma 1 예

김진홍,나종구,윤중한,정민화 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.2

저자들은 비교적 드문 자궁내막에 발생된 Mullerian adenosarcoma 예를 경험하였기에 간단한 문헌고찰과 함께 보고하는 바이다. Mullerian adenosarcoma is a distinctive type of mullerian mixed tumor. We report a rare case of mullerian adenosarcoma of endometrium with a brief review of the literature.

내인성 성호르몬과 인체 자궁평활근의 β-아드레날린성 수용체와의 관계

이종건,나종구,문봉태,홍경선,신진웅,이경숙,노정숙 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.1

저자들은 월경주기 및 임신에 따른 내인성 성홀몬의 생리적 변화가 자궁평활근내의 β-아드레날린성 수용체의 농도와 친화력에 영향을 주는지 알아보기 위하여 β-아드레날린성 수용체의 결합측정검사를 위한 방사능 표지물질로 최근에 이용되기 시작한 특이성과 친화력이 높은 125Iodine labelled iodocyanopindolol을 사용하여 중여포기 여성(13예), 중황체기 여성(12예), 폐경기 여성(9례)와 만삭 임신부(8예)에서 β-아드레날린성 수용체를 측정하여 다음과 같은 결과를 얻었다. 1. 경하지만 순수한 에스트로겐 자극이 있는 주여포기(estradiol;25~75pg/ml, progesterone;$lt;1ng/ml) 여성들에서의 β-아드레날린성 수용체농도와 해리상수는 각각 63.4±22.2fmol/mg protein, 32.4±13.6pmol/L였다. 2. 증가된 에스트로겐 자극외에도 프로게스테론 자극이 함께하는 시기인 중황체기(estradiol; 100~300pg/ml, progesterone; 5~20ng/ml)여성들에서의 β-아드레날린성 수용체의 농도와 해리상수는 각각 40.8±12.7fmol/mg protein, 30.8±11.7pmol/L였다. 3. 낮은 내인성 호르몬농도로 특징 지워지는 폐경기(estradiol;10~20pg/ml, progesterone; $lt;0.1ng/ml)여성들에서의 β-아드레날린성 수용체의 농도와 해리상수는 각각 52.8±11.0fmol/mg protein, 28.1±8.1pmol/L였다. 4. 매우 고농도의 에스트로겐과 프로게스테론이 함께 존재하는 시기인 만삭임신(estradiol;10~45ng/ml, progesterone; 75~250ng/ml)여성들에서 β-아드레날린성 수용체의 농도와 해리상수는 각각 32.5±10.3fmol/mg protein, 36.9±15.7pmol/L였다. 5. 증여포기 여성에서의 β-아드레날린성 수용체의 농도는 중황체기 여성과 만삭임신부에 비하여 의의있게 높았다. 6. 만삭 임신시의 β-아드레날린성 수용체의 농도는 비임신 자궁의 β-아드레날린성 수용체보다 유의하게 낮았다. 그러나 해리상수 값은 중여포기, 중황체기, 폐경 및 만삭 임신간에 유의한 차이가 없었다. 이상의 결과로 볼 때 인체 자궁평화근내 β-아드레날린성 수용체가 내인성 성호르몬에 의하여 이형의 조절을 받는 것으로 사료되나 β-아드레날린성 수용체의 농도변화가 월경주기에 따른 자궁평활근의 수축반응에 관여하지 않는 것 같다. The adrenergic response of the myometrium and concentration of adrenergic receptors in influenced by exogenous gonadal steroids in rabbit uteri. In human studies, it was also observed many years ago that the uterine contractile response to catecholamine stiumlation could be modulated by changes in the gonadal steroid environment. The ability to inhibit uterine contractions by activation of β-adrenergic receptor (myometrial relaxation) has clinical applications for the treatment of preterm labor. In order to prove the hypothesis that endocrine changes at different phases of the reproductive cycle and gestation might alter the β-adrenergic receptor concentration and affinity, we quantitated β-adrenergic receptor concentration and affinity in myometrium from women during the mid-follicular phase, mid-luteal phase, in postmenopausal women and from women at term pregnancy. Using the radiologand idione 125-labeled iodocyanopindolol with high specific activity and high affinity, the β-adrenergic receptor concentrations were determined. The results were as follows; 1. β-adrenergic receptor concentration and dissociation constant (Kd) were 63.4± 22.2fmol/mg protein and 32.4±13.6pmol/L, respectively from women during the mid follicular phase (estradiol:75~75pg/ml, progesterone:$lt;1ng/ml) of the cycle which corresponded to pure but mild estrogen stimulation. 2. β-adrenergic receptor concentration and dissociation constant (Kd) were 40.8± 12.7fmol/mg protein and 30.8±11.7pmol/L, respectively from women during the midluteal phase (estradiol; 100~300pg/ml, progesterone; 5~20ng/ml) of the cycle which correspond to increased estrogen stimulation, combined with progestestational stimulation. 3. β-adrenergic receptor concentration and dissociation constant (Kd) were 52.8± 11.0 fmol/mg protein and 28.1±8.1pmol/L, respectively from women in postmenopaual phase (estradiol;10~20pg/ml, progesterone; $lt;0.1ng/ml) which are characterized by low circulating levels of gonadal steroid homones. 4. β-adrenergic receptor concentration and dissociation constand (Kd) were32.5± 10.3 fmol/mg protein and 36.9±15.7pmol/L, respectively from women with term pregnancy (estradiol; 10~45ng/ml, progesterone; 75~250ng/ml) which are characterized by very high levels of both estrogen and progesterone. 5. The concentration of β-adrenergic receptor during the mid-follicular phase were significantly increased compared with those during the mid-luteal phase and at term pregnancy. 6. The concentration of β-adrenergic receptor at term pregnancy were significantly decreased compared with those from the non-pregnancy myometrium. But there was no significant difference in dissociation constant (Kd) among the mid-follicular phase, mid-luteal phase, postmenopausal and term pregnancy. The findings suggest that the β-adrenergic receptors in the myometrium might be modulated by endogenous gonadal steroid hormones. But the alteration of myometrial contractility during menstrual cycle and pregnancy may not be directly mediated by β-adrenergic system.

소의 경관점액과 계란흰자를 이용한 사람 정자 침투능과 정액 매개 변수와의 관계

이헌영,김진홍,나종구 대한산부인과학회 1990 Obstetrics & Gynecology Science Vol.33 No.9

저자들은 남성 불임의 평가에 중요한 부분을 차지하고 있는 정자-경관점액 상호작용 검사에 있어서 그동안 이용되어온 사람 경관점액, 소의 경관점액의 대용으로 계란흰자의 이용 가능성을 알아보고, 일반 정액검사의 정액매개변수들이 정자-경관점액 상호작용에 어떤 상관관계가 있는지를 알아보고자 최근 1년이내 분만을 했거나, 현재 임신중인 여성의 건강한 남편 15명을 1군으로, 그리고 1년이상 불임인 부부에서 여성 배우자의 기초 불임검사에서 이상이 없었다고 판정된 62명을 2군으로, 이중 안성측 일반 정액검사에서 비정상 정액 매개변수를 보인 경우와 남편측의 분명한 불임의 원인이 밝혀진 13명을 3군으로 하여 소의 경관점액을 이용한 Penetrak과 계란 흰자를 시각적 선명도가 좋은 납작한 모세관에 채워 각각 정자-경관점액 상호작용 검사를 비교하여 다음과 같은 결과를 얻었다. 1. 1군에서 2군에 비해 모든 정액 매개 변수들의 평균값이 높았다. 2. 1군에서 정자 침투거리의 평균값은 penetrak과 계란흰자 각각에서 39.00±7.29mm, 41.40±6.67mm이었고, 2군에서는 29.67±10.04mm, 32.20±10.02mm로 두 점액 배지에서 정자침투거리 사이에는 통계적으로 유의한 상관관계를 보였다. 3. 2군에서 두 점액에서의 정자 침투거리의 평균값과 정액 매개변수들의 평균값의 관계를 비교하여 본 바 정액 매개 변수들 중 정자 운동성, 진행도의 평균값이 정자 침투거리와 유의한 상관관계를 보였다. 4. 1군, 3군의 정자 침투거리를 비교하여 본 바, Penetrak과 계란 희자 각각에서의 정자 침투거리 평균값은 통계적으로 유의한 차이를 보였다. 이상의 결과로 정자-경관점액 상호작용의 배지로서 계란 희자는 사람 경관점액 대용으로 이요 가치가 있을 것으로 생각되며, 임상에서 실용화되기 위해서는 신선한 계란 희자의 선택과 오염방지를 위해서 세심한 고려를 해야 할 것으로 생각된다. Various sperm penetration tests have been used to determine abnormalities of spermcervical mucus interaction for male fertility assessment. Recently, much attention has been directed to the feasibility of substituting mucus for human cervical mucus(HCM). Therefore, this study was performed in order to comparison between bovine cervical mucus(BCM) and fraction of Hens egg white(FEW) as substituting mucus for human cervical mucus with the use of ejaculated human spermatozoa from 15 fertile men(Group 1), 62 infergile couples(Group 2) and 13 male partners(Group 3) with proven male infertility factors of 62 infertile couples. The female partners of 62 infertile couples showed normal results in the female fundamental test for fertility. Conventional semen analysis was evaluated according to the WHO standard manual using Markler counting chamber. Sperm-cervical mucus interation tests were performed in a flat capillary tubes with BCM and FEW. The tubes were incubated in a subsample of semen vertically at room temperature for 90 minutes. The depth of penetration was observed microscopically. Results were as follows: 1. Group 1 showed higher in the mean values of seminal parameters than Group 2. 2. In Group 1, the depth of sperm penetration in BCM was 39.00±7.29mm and in FEW was 41.40±6.67mm. In Group 2, the depth of wperm penetration in BCM was 29.67±10.04mm and in FEW was 32.20±10.02mm. Also, 1 fertile man of Group 1 and 11 infertile men of Group 3 showed abnormal sperm penetration. A significant correlation was found between sperm penetration of Group 2 in BCM and FEW(P$lt;0.001). 3. In Group 2, the depth of sperm penetration in both BCM and FEW were significantly correlated with sperm motility and porgression of seminal parameters(P$lt;0.001). 4. The mean values of sperm penetration for both BCM and FEW were significantly different when sperm penetration of Group 1 and Group 3 were compared(P$lt;0.001). In conclusion, FEW can be effectively substituted for BCM, HCM in laboratory testing of sperm-cervical mucus interaction and this simple, inexpensive test may identify functional deficiencies in sperm motility and it has become in adjunct to conventional semen analysis.