비침윤성 자궁경부암의 조기진단과치료

송승규(SK Song),김승조(SJ Kim) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.2

지난 10여년동안에 자궁경관의 암전구병소에 대한 특성, 병리, 진단 및 치료에 있어서는 많은 연구와 발전을 보게 되었으며 자궁경부암으로 인한 사망율이 현저히 감소되었다. 이러한 표면상피의 병소들을 편의상 종합하여 경관상피내 종양(cerivical intraepithelial neoplasia), 이형증(dysplasia)및 상피내암(carcinoma in site) 등이라고 부르고 있다. 임상적 진전분야를 보면 자궁경질 세포진 이용도의 증가, 질확대경 이용도의 증가, 세포진이 비정상인 환자에 대한 보다 나은 평가, 그리고 보다 나은 일차요법(primary therapy)등을 들 수 있다. 또한 기초연구분야의 진전을 보면 자궁경관종양과 "헤르페스 바이러스" 제 2형(Herpes virus type 2)과의 관련성, 일련의 자궁경관 상피내종양에 대한 올바른 이해,그리고 침윤성 암종에 대해 개선된 일차요법을 유도하는 임상적 시도 등을 들 수 있다. 그러나 실제 치료와 관리면에서 현재 문제가 되고 논란이 되는 것은 비정상적 세포진을 보인 모든 환자에 대하여 자궁경관을 원추절제(cervical conization) 할 것인가? 또 이형중의 의의는 무엇인가? 상피내암 환자 수술에 있어서 질벽(vaginal cuff)의 절제를 넓게 시행하여야 할 것인가 하는 문제가 있다.

제왕절개후 자궁반흔의 X선 자궁조영술에 의한 관찰

송승규(SK Song),최성기(SK Choi),김영환(YW Kim) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.10

Understanding of the morphology and morbidity of the uterine scars that form following cesarean section is of freat help in preventing possible rupture of the uterus and to select the type of delively on the subsequent pregnancy. The present study has been undertaken to make observation on the uterine changes revealed by hysterogram. The clinical materials were consisted in 44 women who had at least one previous cesarean section, and also in 10 normal parous women after normal vaginal delivery as the control. The hysterogram was performed by Kjellberg`s method employing fractionation of the contrast medium(Lipiodolⓡ 25%) according to Hyam`s recommendation. The following results and conclusions were obstained. 1. Of 44 women with previous cesarean section, 31.8% showed normal hysterofram, In the remain- ing patients, hysterographic abnormalities of various degree were noted. The most frequent type od X-ray changes was a mild outpouching at the site of previous surgery, i.e., isthmus or so-called lower uterine segment(during pregnancy). 2. The deformation of the uterus on husterogram in the patients with multiple cesarean sections was more prominent and marked than in the patients with single operation. 3. There is no relationship between the degree and type of deformation and such periparturient complications as prematured rupture of the membrance, prolonged delivery, post-operative febrile episode (a fever higher than 38℃), or post-operative abdominal infection. On the other hand, all these factorts excepting premature rupture of the membrance seem to have some form of influence on the incidence of the scar formations.

자궁경부의 상피내암 및 전암성 병소에 관한 임상적 관찰

송승규(SK Song),권오석(OS Kwon),김대훈(DH Kim),김수평(SP Kim) 대한산부인과학회 1974 Obstetrics & Gynecology Science Vol.17 No.4

가톨릭 의과 대학 산부인과학 교실에서 1966년 1월부터 1973년 6월까지 만 7년 6개월간 세 포 조직학적으로 CIS Dysplasia로 진단된 118명의 환자에 대해 소급적 관찰을 시도하여 다 음과 같은 결과를 얻었다. 1) 연령별 분포는 CIS에서 43.8세, Dysplasia에서 41.1세였다. 2) 분만 횟수는 CIS에서 평균 4.3회, Dysplasia에서 4회였고 CIS에서 2예의 월발성 임신이 있었다. 3) 초혼 연령은 CIS에서 평균 21.6세, Dysplasia에서 평균 20.7세였다. 4) 임상 증상은 CIS 및 Dysplasia 모두 약 65%에서 있었고 35%에서 가벼운 증상이나 증상 이 거의 없었다. 5) Pap`s smear 음성군에서도 CIS 21%, Dysplasia 29%가 발견되었다. 6) 55예의 수술적 조작이 시행된 CIS 및 Dysplasia 환자 중 48예에서 자궁 적출술이 시행되 었고, 7예에서 원추형 생검술이 시행되었다. 7) 수술적 조작이 시행된 25예에서 6개월부터 5년간 추적 검사가 가능하였는데 원추형 생검 술을 시행하였던 Dysplasia 1예에서 2년 후에 뚜렷한 세포 증식이 있었고 응급을 요하는 부 인과 질환으로 자궁 적축술을 받은 CIS 1예에서 3년 후엔 vaginal cuff에 cancerization이 있었다. 8) 수술적 조작을 받지 않았던 16명의 추적 검사에서 5예의 Dysplasia는 호전이 없었다. 또 3예의 CIS에서는 조기 침윤성 암으로 악화된 것을 볼 수 있었다. Authors retrospectively analized one hundred and eighteen patients with CIS(carcinoma in situ) and dysplasia detected cytopathologically at Catholic Medical College from January, 1966 through June, 1973. The results were as follows : 1) The average age was 43.8 years in CIS and 41.1 years in dysplasia. 2) The average pregnancy numbers were 4.3 in CIS and 4 in dysplasia. 3) The average age of first marriage was 21.6 years in CIS and 20.7 years in dysplasia. 4) The clinical symptoms were noted in 65 percent of both CIS and dysplasia, and there were no symptoms or minimal symptoms in 35 percent fo cases. 5) 21 percent of CIS and 29 percent of dysplasia were detected in negative groups of Papanicolaou`s smear. 6) 48 of the patients who had operation performed were treated by hysterectomy, and conization was performed in remaining 7 patients. 7) The follow up in only 25 patients who had operation performed was possible during 5 years from 6 months after operation, one patient of dysplasia treated by conization was clearly defined with cellular hyperplasia, and one patient of CIS detected incidentally after energency total hysterectomy was transmitted to invasive carcinoma at vaginal cuff. 8) 5 percent of dysplasia who had not performed operation were improved in follow up study, in 6 cases of CIS and 2 cases of dysplasia were not improved. 3 patients of CIS were transmitted to early invasive carcinoma.

삼태임신의 1례

송승규(SK Song),정희자(HJ Chung),손순희(SH Sohn),현춘(C Hyun) 대한산부인과학회 1970 Obstetrics & Gynecology Science Vol.13 No.1

This is a case of tripple pregnancy which we had experienced at st. Paul`s hospital last May, and the third baby was associationed with hyaline membrance disease.

조기파수로 인한 태반염의 임상병리학적 연구

최성기(SK Choi),송승규(SK Song),박찬동(CD Park),이경희(KH Lee) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.7

The clinico-pathological studies on the placentitis were based on 32 cases of the premature ruprure of membranes which were selected on dept. of obstetrical service, St, Mary`s Hospital, Catholic Medical College, from Aug. to November 1968. 1. The prevalence of neutroptilic infiltration, especially in the decidua of the membranes, in placentas of women who were delivered on our service, is described. 2. Of the placentas examined by the 4 section method, 75 per cent had neutrophilic infiltration in the cases of premature rupture of membranes. 3. Moderate or severe placentitis (GradeII,III) could be correlated with premature rupture of mombranes. 4. No significant differences between normal and infected placental were noted in the matermal ages, parities, and dutation of labor. 5. The distal and proximal portion of the umbilical cord were found to be useful areas for determining whether or not severe placentitis is present, in as much as the presence of a definite neutrophilic infiltration in microscopic sections from both of these cord areas almost invaria- bly meant the presence of a severe placentitis. 6. Maternal blood leukocytes were likely seemed to be proportionate to degree of placentitis. 7. Of the amniotic fluid cultivated, 53.1 per cent had microorganisms in the placentitis due to premature rupture of membranes. Staphyloclccus and Escherichia coli were more prevalent pathogens in the premature rupture of membranes. 8. Furadantion and kantrex were useful antibiotics in the management of the placentitis.

방광결석으로 인한 난산 1예

황상의(SU Hwang),송승규(SK Song),황순경(SK Whang),김승조(SJ Kim) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.4

임신 40주 초산부에서 하나의 큰 방광 결석의 합병으로 태아의 산도통과를 방해하여 난산을 초래함으로써 복식분만 및 결석제거술을 하였다. 본 예는 그외 신수종, 수뇨관수종 및 만성방광염을 동반하였다. A case of dystocia caused by a large bladder stone complicated in term pregnancy was presented. This 30 year-old primipara also was combined with hydronephrosis, hydroureter and chronic cystitis. The textbook and papers concerned to this problems were reviewed briefly.

원발성외음암과 원발성자궁경부암이 합병된 1예

최희원(HW Choi),송승규(SK Song),이헌영(HY Lee) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.3

이상을 요약하면 부인과의사는 cervix, vagina, vulva 등에 종양을 가진 환자를 치료하기 전에 multicentric neoplastic change in large epithelial field를 염두에 두어 다른 부위에 종양이 잇는지 여부를 철저히 검사할 것이며 또한 한 부위에 종양을 치료한 후에 주기적으로 다른 부위를 추적 검사하여야 한다. Primary vulva carcinoma is rare disease, and multiple primary malignancy in lower genital tract of the same individual is very rare. A case of vulva ca. arising from labium minor combined with cervix carcinoma in 46 years old multiparous woman was presented. The patients was treated with radical vulvectomy and hysterctomy and she had been followed for 3 years without any complications and evidence of recurrence. And a brief review of the theory of multicentric ongin in lower gentital tract on the literature is made.

선천성질결손증의 Baldwin씨 인공조질술의 변법

김승조(SJ Kim),송승규(SK Song),최태일(TI choe) 대한산부인과학회 1968 Obstetrics & Gynecology Science Vol.11 No.10

The purpose of this paper is to describe a modified method of Baldwin`s operation, follow up study and review of literature in congenital absence of Vagina. In order that blood supply may not be interrupted, author made transeverse invagination against of vertical invagination of the original Baldwin`s method, with intestinal loop into the tunnel which was newly made by vaginal procedur. Vaginal vestibulum was tracted upward to help epithelizatiou, and sutured with intestinal loop which should be vaginal opening. The intestinal which was invaginated into the tunnel was sutured by chromic cat gut and 3-O silk on all sides of urethral and rectal surface of the tunnel for the purpose of preventing hernia. Author obtained successful result with use of the recent advancement of antibiotics, electrolyte balance and anesthesia, and a modified Baldwin`s method for formation of the artifical vagina as following. In follow up study on 6 months duration. 1) There were no hernia, peritonitis or sepsis. 2) New epithelization upward 3.3 cm from introtius was revealed. 3) Non significant changes were seen in Pap`s smear, vaginal smear and culture in the artificial vaginal canal during 6 months follow up after operation. 4) Discomfort or irritation due to vaginal discharge were not revealed. 5) Successful anatomic, physiologic and pschonseual responses were obtained.

융모성상피암에 있어서의 Methotrexate 포화검사의 의의

김승조 ( SJ Kim ),송승규 ( SK Song ),이헌영 ( HY Lee ),정재근 ( JK Jung ),안웅식 ( WS An ),최원영 ( WY Choi ) 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.7

저자들은 융모성질환의 화학치료에 있어서 methotrexate 치료도중 문제가 될 수 있는 약제의 독성을 줄이고, 내성을 방지하기 위하여 leucovorin rescue를 주는 적절한 시기 및 용량을 결정하고자 methotrexate 포화검사를 시행하여 다음과 같은 결론을 얻었다. 1. Methotrexate혈중치는 methotrexate의 정맥내 주사후 30분에 최고 농도에 달하며, 그 반감기는 5.04±2.05 시간이었다. 2. Methotrexate정맥내 주사후 24시간후와 28시간후에 30mg이 folic acid를 줄때 혈중 methotrexate 평균농도는 24시간후에 50μmole/liter였고, 48시간후에 0.32μmole/liter이었다. 3. Methotrexate치료중 약제의 독성과 반감기를 비교해 본 결과 반감기가 평균보다 긴 경우 그 약제의 독성이 강한 것으로 보이나 통계적인 유효성은 없는 것으로 나타났다. Methotrexate 치료중 약제의 족성과 methotrexate 정맥주사후 48시간의 methotrexate 혈중치를 비교해 본 결과 간독성에 있어서는 유의한 차이가 없으나, 혈액학적 독성에 있어서는 methotrexate 혈중치가 평균보다 높은군이 낮은군에 비해 강한 독성이 나타났다. 이상과 같이 저자들은 methotrexate의 항암화학 요법에 있어서 강한 약제의 독성을 나타낼 가능성이 있는 환자를 알아내는데에 methotrexate 포화검사가 유용하게 쓰일 수 있으며, 약제의 독성을 나타낼 가능성이 큰 환자에 있어서는 methotrexate 혈중농도를 측정하여야 그에 따른 leucovorin rescue를 시행하여야 한다고 결론지었다. The clinical pharmacology of methotrexate, administered in conventional intravenous doses, has been studied extensively in man utilizing a variety of assay techniques. However, only a few studies have been undertaken to investigate the pharmacology of intermediate doses of methotrexate followed by delayed rescus with citrovorum factor. So, we have got following conclusion, which is drawn by methotrexate saturation test. With that, we may eliminate drug resistance which can be the main problem in methotrexate chemotherapy and we can figure it out the proper timing or dosage of leucovorin rescue for more efficient anticancer chemotherapy. The results as follows; 1. Methotrexate serum level reaches up to the highest point in 30 minutes after the intravenous infusion, and 5.04±2.05 hour is its half life. 2. In case leucovorin rescue is used, we give it folic acid 30mg, without regarding methotrexate serum level, within 24 and 48 hours after methotrexate intravenous infusion. 3. During the methotrexate chemotherapy, the relation with drug toxicity and half life remains longer than average, the drug toxicity is a not stronger. But there seems no strict statistical significance. In case of hepatotoxicity, there is no special difference between the drug toxicity of methotrexate chemotherapy and the serum level after 48 hours of methotrexate intravenous infusion. But in case of hematologic toxicity, the group of higher methotrexate serum level appear a stronger toxicity than the lower methotrexate serum level group. Therefore, authors made it a conclusion that methotrexate saturation test should be done to identify patients who would react to the drug toxicity in case of anticancer chemotherapy of methotrexate, and to administate the proper leucovorin rescue for preventing drug toxicity.

부인과적 병소에 대한 선택적인 골반장기혈관 조영술

김철성(CS Kim),김성기(SK Kim),송승규(SK Song),김승조(SJ Kim),신경섭(KS Shin) 대한산부인과학회 1975 Obstetrics & Gynecology Science Vol.18 No.11

Pelvic Angiography is simple and safe procedure, may be of great help in early diagnosis and management of gynecologic lesions, especially malignant trophoblastic neoplasms. Malignant trophoblastic neoplasm is a relatively common disease in Korea as other countries. We have attempted to analyze the pelvic angiographic findings in 15 patients. who were 6 cases of trophoblastic disease, 6 cases of cervical cancer and 3 cases of other diseases. The results were obtained as follows; 1. Malignant trophoblastic neoplasms were found more typical changes consisting of opacified irregular vascular spaces with early draining vein, pooling of contrast medium around central avascular areas, displacement of vessels by tumor masses and persistnet stains 2. By pelvic angiography it is valuable diagnostic procedure to make an early diagnosis of choriadenoma destruens which can not be deteceted by curettage and hCG test. 3. By pelvic angiography the metastatic lesion and location can be detected in cervical cancer over clinical stage III.