중독 임신중독증에 병발한 무뇨증 1치험예

정원영(WY Chung),이교웅(KW Lee),권순욱(SW Kwon) 대한산부인과학회 1964 Obstetrics & Gynecology Science Vol.7 No.8

1. 중독임신중독증으로 인하여 초래된 급성신기능부전의 일례를 경험한 바 있어 보고하였다. 2. 입원후 첫 2-3일 간의 수분공급은 600+배설량의 원칙에 비하여 다소 과량을 공급함으로 인하여 조기에 폐수종을 초래하게 된 동기가 된 것으로 생각된다. 3. 환자는 7일째 tracheotomy를 시행한 후 극적인 호전을 보며 congestive heart failure의 위기를 모면하였다. 4. Rheomacrodex 투여로 신장순환을 촉진시키고 만족스러운 이뇨작용을 얻을 수 있었다. 5. 발병 6개월 후에는 신장기능의 완전 회복을 확인하였다. ... 자간증... 임신성고혈압.... The Case reported was 36 years old women who had eclampsia on delivery and developed acute renal failure. Therapy initially is directed toward the Control of water balance. The patient was tried to maintain on 600 cc of water plus the measured fluid loss. Tracheotomy was performed because patient was unable to expectorate her coughing sputum on 5 th date of admission. Hyperkalemia accompamy critical event. During diuretic phase, patient was replaced the adequate amount of sodium, potassium and water. Repeated blood and uriuary biochemistry returued normal level on 27th of postpartum date but low urine specific gravity which was restored completely on 5 months later.

각종 갑상선 질환이 요중 17 - Ketosteroids, 17 - Hydroxycorticosteroids 및 Pituitary Gonadotropin배설과 Thorn Test 성적에 미치는 영향에 관한 연구

정원영(WY Chung) 대한산부인과학회 1965 Obstetrics & Gynecology Science Vol.8 No.5

The influences of various thyroid function states on the adreno-cortical functions were strdied through the measurement of the urinary excretion of 17-Ketosteroids, 17-Hydroxycorticosteroids and pituitary gonadotropin. The Thron test was also carried out with the intramuscular injection of 25 mg of ACTH and the changes in the circulating eosinophil cell count, urinary excretion of 17-KS and 17-OHCS were also evaluated. The materials selected were 96 female patients with various thyroid diseases, namely, 41 hyperthyroid, 29 euthyroid and 12 hypothyroid. The follow up studies were done in 13 hyperthyroid and 6 hypothyroid patients after the appropriate treatment. Following were the results: 1) The mean values of 24 hr excretion of urinary 17-KS were: 11, 11±2.97mg in euthyroid, 10.18 ±3.14mg in hyperthyroid, and 7.01±2.68mg in hypothyroid groups respectively. Thus the excretion of urinary 17-KS showed a slightly lower in hyper-, and a markedly lower in hypothyroidism. The mean values of 24 hr excretion of urinary 17-OHCS were: 0.72±0.25mg in euthyroid, 0.81±0.29mg in hyperthyroid, and 0.44±0.16mg in hypothyroid groups respectively. Thus the excretion of urinary 17-OHCS showed a slightly higher in gyper-, and lower in hypothyroidsim. 2) The follow up studies revealed statistically significant differences between the values before and after the treatment. In hyperthyroidism, the 24 hr excretion of urinary 17-KS were 10.17±2.86 before, and 11.70±3.28mg after the treatment, while the 24 hr excretion of urinary 17-OHCS were 1.16±0.28 mg before, and 0.82±0.27mg after the treatment. In hypothyoidism, the 24 hr excretion of urinary 17 KS were 5.34±2.06mg before, and 7.75±3.18mg after the treatment, while the 24 hr excretion of urinary 17-OHCS were 0.34±0.08mg before, and 0.65±0.33mg after treatment. 3) The 24 hr excretion of urinary 17-KS and 17-OHCS were also determined before and after the intramuscular injection of 25mg of ACTH. In euthyroidism, the 17-KS values were 11.27±2.04mg before and 13.44±1.46mg after ACTH, while the 17-OHCS values were 0.68±0.23mg before, and 0.96±0.20mg after ACTH. In hyperthyroidsism the 17-KS values were 9.26±3.48mg before and 10.70±2.23mg after ACTH, while the 17-OHCS values were 0.78±0.23mg before, and 0.93±0.25mg after ACTH. In hypothyroidism, the 17-KS values were 4.99±2.44mg begore, and 5.86±3.39mg after ACTH while the 17-OHCS value were 0.35+0.07mg before, and 0.58+0.28mg after ACTH. Thus the reponses to the 17-OHCS balues were 0.35±0.07mg before, and 0.58±0.28mg after ACTH. Thus the responses to the 17-OHCS values were 0.35±0.07mg before, and 0.58±0.28mg after ACTH. Thus the responses to ACTH were: adequate in euthyroid, inadequate in hyperthyroid and significant in hypothyroid. 4) The eosinophil cell counts after the intramuscular injection of 25mg of ACTH showed a marked decrease in eu-, and hyperthyroid group, while an inadequate response in hypothyroid group, which, however, showed the normal responses after the treatment. 5) The excretion of urinary pituitary gonadotropin were in normal range in eu-, and hyperthyroid groups, while a very low values in some myxedema patients along with the lower values of 17-KS and 17-OHCS, which, however, also returned to normal range after the treatment.

산아손실을 중심으로한 쌍태아임신의 임상적 고찰

정원영(WY Chung),백성현(SH Baik),문재훈(ZH Moon) 대한산부인과학회 1965 Obstetrics & Gynecology Science Vol.8 No.3

It is reported that the perinatal mortality in twinpregnancy is high, and that the second twin is lost more often than the first. In the present study, we submitted for analysis 101 cases of twin pregnancy admitted to Obstetric Ward, N.M.C. among 5,687 deliveries from January 1959 to the end of 1964. Total number of perinatal deaths was 25, excluding 8 of less than 28 weeks gestation. The perinatal mortality was 127, per 1,000 deliveries. We summerized the result as follows: 1) There were eighteen primigravida and eighty-three multipara. Primigravida have a slightly higher rate of fetal mortality than multipara. 2) Birth weight of the infants was closely related to the main cause of death in each case. One hundred percent of fetal loss occurred in infants weighing under 1,000gm, whereas the fetal loss among 1,000-2,000 group was 43.8% of the first twin and 34.8% of the second one, and 7.9% of the first, 10.0% of the second respectively among the group 2.000-2,500g. In the group weighing more than 2,500 g, the fetal loss was 2.3% of the 1st twin, and 7.1% for the second twin group. The critical birth weight in connection with fetal loss would appear to be 2,000 g. 3) As to the time interval between delivery of the first and the second infant in our series, two thirds of the second twin were delivered within 30 minutes with 12.8% mortality. However, fetal mortality of the second twin was 100% after 60 minutes in 3 cases. 4) In 51 registered cases, 4(7.8%) cases were diagnosed for twins after the first twin was delivered. In 50 unregistered cases, 10(20%) cases were diagnosed after the first twin. The importance of diagnosing the presence of the second twin before administering any oxytotic drug cannot be over emphasized. On 3 occasions where such drugs were administered, both the second infants subsequently died. 5) If 10.0g/100ml hemoglobin is used as a tentative borderline value for anemia of 51 registered cases, only 10 were anemic, while 31 of unregistered cases had moderate or severe anemia. 6) Twenty-one cases were under care for toxemia among 51 of registered cases. and 24 in 50 unregistered. There were no evidence of eclampsia in the registered cases. whereas 6 of the unregistered toxemic patients had eclamptic fit. 7) The fetal loss of second twin showed slightly high mortality rate in breech than cephalic delivery in ourseries. In two cases in our series, total hysterectomy was carried out due to atonic bleeding. There were 4 cases of congenital anomalies: thoracopagus, anencephalus and heart anomaly.

뇨루의 임상적 관찰

정원영(WY Chung),권순옥(SU Kwon) 대한산부인과학회 1964 Obstetrics & Gynecology Science Vol.7 No.2

1. 56예의 요루에 대한 임상적관찰소견을 보고하며 원인별로는 난산으로 인한 요루발생수가 가장 많았다. 2. 수반된 제여건과 수술전처치와 예후에 관하여서 문헌적고찰과 경험을 기술하였다. 3. 수술의 방법에 있어서 여러가지 방법을 소개검토하였으며, 특히 Sims 방법과 Collins 방법을 가장 많이 시행하여 좋은 성적(제2표)을 얻었으나 suprapubic approach 는 만족할만한 결과를 얻지 못하였다. 4. 36예의 환자중 28예에서 1회수술을 하여 19예에서 성공하였으며 7예에서 2회의 수술을 하여 4예에서 성공하였으며 1예에 있어서는 4회 수술을 시도하였으나 실패하였다(제14표). 5. 수술후 감량으로 인한 합병증은 13예에서 볼 수 있었으며 뇨배양검사에서 E. Coli의 감량이 가장 많았다. 1예는 폐기전으로 수술후 18일에 급사하였으며 이는 부검으로 확인되었다. 4예에서 urinary incontinence 가 속발하였으나 이는 괄약근의 손상이 기능적으로 치유되지 못했기 때문이었다. 6. 수술의 실패에 대하여 검토해본 결과 제15표와 같은 결과를 얻었으나 특히 catheter 폐쇄로 인한 요루의 재발은 술후처치를 주의깊게 함으로서 피할 수 있는 점으로 사료된다. Our study represents the review of the case histories of 36 patients admitted to or discharged from National Medical Center with diagnosis of urinary fistula, from January 1959 through end of 1963. The causes of these fistulas were analysed and methods of management were reviewed. Particular attention was paid to those patients in whom surgical repair of the fistula was carried out and an attempt was made to evaluate the factors responsible for success of repair. Of 56 cases of urinary fistulas studied, 26 were the result of obstetric dystocia and 16 were associated with abdominal operations including Wertheim`s operation and in the remainder of the cases the lesion were related to chemical cauterization for treatment of prolapse of uterus and TB. These cases were compared with Dr. Ruseel`s 74 cases, which besides ordinary obstetrical fisseries tulas also included urinary fistula due to radium therapy and vaginal operations, where as in our no such cases were seen. Six of the fistulas healed spomaneously. One was an obstetrical fistula while others five were fistula which occured as the result of radical operation for cervical cancer. In 36 patients operative procedure were carried out on 45 occasions. These operations were mostly designed to close the fistulous opening by the vaginal approach but in 15 cases abdominal approach was used. In 20 cases of large fistulas the ureteral orifices were found either at the edge of the fistula or near to it. In most of those cases extensive scar formation with poor circulation was found. Of these 20 cases eight were discharged as inoperable, five were operated by interposition of uterus or Martius operation in combination with layer to layer closure after insertion of ureter catheter. In the remaining 7 cases the fistulas were so large and fibrosis were so extensive that it was impossible to make sufficient mobilization of the surrounding tissue to make suture without tension. Operation was carried out in 86 cases, complete cure were 21, in complete cure in 4 cases where urinary incontinence followed after the operation despite closure of fistula, failure in 11 cases. Certain general principles for management of vesicovaginal fistula were described. 1) Complete urologic study and diagnosis. 2) Elimination of infection before and after operation. 3) Optimal time of operation about 6 months after fistula developed. 4) For good operative result it is very important to make good exposure of vaginal tract, to make complete excision of scar tissue, to make sufficient mobilization and suture always to apply sutures in healthey tissue without tension. 5) Continuous, effective postoperative bladder drainage for days should be carried out to allow solid healing of bladder wound.

융모종양에 관한 임상병리학적 고찰

김영기(YK Kim),정원영(WY Chung),(J.V.Thorborg) 대한산부인과학회 1965 Obstetrics & Gynecology Science Vol.8 No.2

1958년 11월부터 1963년 9월말까지 (4년 10개월간) 국립의료원 산부인과 및 병리학과에서 취급한 융모종 73예에 대하여 병리조직학적으로 재검토분류하여 임상적으로 고찰하였다. 그 중 포상기태 35예(48%), 파회성 융모선종 10예(14%), 및 융모암 28예(38%)였으며 동기간 중 관찰한 총여성성기악성종양 540예에 대한 융모암의 발생율은 4.9%이었고, 융모종은 동기간 중 총임신(4726예)의 1.3%에 해당하며, 0.6%가 융모암이었다. 즉 77임신에 대하여 융모종이 1,169임신에 대하여 융모암이 1의 비율을 보였다. 이와같은 높은 빈도는 Asia각국의 보고-인도,중국, 대만, 홍콩, 싱가폴, 필리핀등-와는 대체로 비슷하였으며, 구미각국의 보고와는 현격한 차이를 나타내고 있다. 또한 특기할 만한 차이는 포상기태와 융모암의 빈도를 비교하면 구미에서는 포상기태가 융모암보다 적어도 10배 정도의 고율을 보이는 데 반하여 저자등의 관찰에서는 양자간에 큰 차이가 없었다. 이와같은 차이는 독일인 Huwer씨가 부산에서 경험한 융모종에 관한 발표에서도 일치된 소견을 보았다. 융모종의 발생기전에 관하여 흥미있는 면역학적 관찰을 제창한 Scott씨가 말한 바와 같이 고령, 초임부에 발생빈도가 높다던가 혈액형의 분포에 관한 뚜렷한 차이등은 본관찰에서는 발견하지 못하였다. 1)포상기태 26예의 포상기태 중 15예에서 최종정상월경후 3∼4개월에 진단되었고, 거이 전예에서 자궁출혈이 주소이었다. 무월경기간에 비하여 자궁의 크기가 이상적으로 컸던 것이 12예, 일치된 것이 4예, 오히려 적엇던 것이 10예이었다. 포상기태 가료후 파회성 융모선종 8예, 융모암 2예의 병발을 보았으며, 5예에서 정상분만을 하였고, 반복성 태상기태는 볼 수 없었다. 80%이상이 자궁소파술 실시후 4주이내에 뇨의 임신반응 검사가 음성으로 변하였으며 계속 양성이었던 2예에서는 후에 융모암으로 발전하였다. 포상기태 전예 중 10예에서 1년 이상 follow up할 수 있었다. Hertig 및 Sheldon씨의 분류법에 의하여 포상기태에 있어서 trophoblastic proliferation의 정도를 재검토조사하여 본 결과 대부분의 예에서 중등도의 증식을 관찰할 수 있었으며, 포상기태가 파회성융모선종 혹은 융모암을 병발하였던 몇 예에서만 약간의 현저한 융모세포 증식을 볼 수 있었던 사실 외에는 별다른 예후에 관한 관련성을 찾아 볼 수 없었다. 2)파회성 융모선종 10예 중 3예에서는 조직학적 진단이 불명확 하였다. 1예를 제외한 전예에서 포상기태가 선행 되었고 1예는 정상분만후에 발생 하였다.3예에서 패전이를 보았으나 융모암으로 변한 예와 사망한 예는 없었다. 9예에 자궁적출술을 시행하였으며, 패전이한 3예(그중 1예는 방광벽까지 침윤되었슴)methotrexate를 투여하여 좋은 효과를 보았다. 3)융모암 최종선행임신은 포상기태가 10예로써 가장 많으며 정상분만이 8예, 인공 혹은 자연유산이 4예였다. 융모암에서도 부정성기출혈이 주소였으며 병리조직학적으로 진단 확정된 22예 중 5예에서만 전이를 볼 수 없었고, 패전이가 가장 많았다.(16예) 5예에서 수술 혹은 methorexate 투여후 8주 이내에 뇨의 임신반응이 음성화 하였고, 16예에서는 지속적으로 양성이었으며 1예에서는 치료전부터 음성이었다. 22예 중 7예는 발병후 3개월 내지 4년이내에 사망하였고, 그 중 6예는 2년이내에 사망하였다. 전이를 일으킨 예는 대다수에 있어서 전신상태가 극히 불량하였으며, 거이 사망 직전에 있었다. 5예에서 부검

Clomiphene Citrate ( Clomid ) 의 임상경험

박찬무(CM Park),최갑식(KS Choi),정원영(WY Chung) 대한산부인과학회 1969 Obstetrics & Gynecology Science Vol.12 No.4

This clinical investigation was based upon 56 cases of primary amenorrhea and infertility for whom clomphene citrate were adminisrered at the Dept. of Obst. & Gynec., N.M.C., from Sept., 1965 to Dec., 1968, and the results are as follows: 1) There was observed no ovulatory cycle during 5 drug cycles in 2 cases of primary ame- norrhea for whom clomiphene citrate 100mg were admunustered for 7 days. 2) There were observed 9 ovulatory cycles in 6 cases of secondary amenorrhea during total 25 durg cycles (36.0%). 3) There were observed 21 ovularory cycles in 10 cases of total 23 cases of oligomenorrhea durg total 47 durg cycles in doses of clomiphene citate 50mg per day for 7 days (44.6%). 4) There were observed 30 ovulatory cycles in 19 cases of total 22 cases of anovulatory cycle during total 46 durg cycles in doses of clmiphene citrate 50mg per for 7 days (65.2%). 5) Total pregnancies were 14;one in secondary amenorrhea, 5 in oligomenorrhea, and 8 in anovulatory cycle patients; the secondaty amenorrhea case is during prengancy. Of 5 olige- menorrhea, 2 during pregnancy, one abortion, and 2 normal term deliveries(male 1, female 1) Of 8 anovulatory cycle patients, 4 during pregnancy, one premature delivery, and 3 normal term deliveries (male 2. female 1).

산모혈청내 CRP농도가 조기진통억제 예후 판정에 미치는 영향

이승호,정원영,박정옥,박윤기,박태규,배철성 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.6

최근 조기진통의 원인으로 불현성자궁내감염이 중요한 요인이라는 보고를 근거로, 본 연구에서는 CRP를 불현성자궁내감염의 표식자로 삼아 1988년 1월부터 1990년 2월까지 영남대학교 의과대학부속병원 산부인과에 입원한 24주에서 37주까지의 조기진통 산모 57명을 대상으로 입원시부터 2일간격으로 CRP량을 추적 측정하였다. 대조군으로서 진통이 없는 24주에서 37주사이의 산모 10명과 양막파열이 없는 만삭산모 33명을 대상으로 하였다. 정량측정된 CRP는 0.7 mg/dl를 기준으로 양성군과 음성군으로 나누어 각 군간의 평균 분만지연일, 분만시 임신주수, 평균 신생아체중, Apgar score, 자궁수축억제치료의 성공율과 만삭분만을 서로 비교하여 다음과 같은 결과를 얻었다. 1. 조기진통 군에서의 CRP정량치는, 두 대조군의 연령, 분만력, 임신중절횟수에 대해 서로간에 유의한 차이가 없었으며, 대상군인 두 군(양성군과 음성군)간에도 연령, 분만력, 임신중절 횟수 및 입원시 임신주수에 유의한 차이가 없었다. 2. CRP정량치는 조기진통군과 두 대조군 사이에는 유의한 차이가 있었다(P$lt;0.01). 3. 입원시 CRP를 정량측정하여 그 결과를 기준으로 양성군과 음성군으로 분류하였을때, 평균 분만지연일과 평균 신생아체중에는 두 군간에 유의한 차이가 있었으나(P$lt;0.05), 분만시 임신주수, Apgar score, 자궁수축억제치료에 대한 성공율, 만삭분만에는 통계학적 유의성이 없었다. 4. 입원 2일 후의 CRP정량을 추적 측정하여, 두 군으로 분류하였을 때 평균분만지연일, 분만시 임신주수, 평균 신생아체중, Apgar score, 자궁수축억제치료에 대한 성공율과 만삭분만율은 두군 간에 모두 유의한 차이가 있었다(P$lt;0.05, P$lt;0.01, P$lt;0.01, P$lt;0.05, P$lt;0.01, P$lt;0.05). 5. 입원 4일 후의 CRP정량을 추적 측정하여, 두군으로 분류하였을 때 평균분만지연일과 자궁수축억제 치료의 성공율, 만삭분만율에는 유의한 차이가 있었으나(P$lt;0.05, P$lt;0.01, P$lt;0.05), 분만시 임신주수, 평균 신생아체중에는 유의한 차이가 없었다. 위의 결과로 미루어 보아 CRP를 입원시 단독 정량 측정하는 것보다 반복추적 측정하므로써, 자궁수축억제치료의 성공여부를 예측하는 데 매우 유용하며, CRP의 정량측정치가 증가하는 경우에는, 임상적 감염의 증거가 없더라도 자궁수축억제치료에 실패할 것을 예견할 수 있었으며, CRP의 정량측정치가 감소한 경우에는 자궁수축억제치료에 성공하여 만삭까지 분만을 연장하는 것을 기대할 수 있었다. Subclinical intrauterine infection is an important cause of preterm labor, specifically where tocolysis has failed. So, 57 pregnant women who admitted to Department of Obstetrics and Gynecology of Yeungnam University Hospital during the period through Jan 1988 to Feb 1990 were studied to determine whether the `postive`(CRP$gt;0.7 mg/dl) or `negative`(CRP$lt;0.7 mg/dl) of the C-reactive protein, a marker for subclinical intrauterine infection, would correlated with success or failure of tocolysis. C-reactive protein was serially measured by means of Turbidimetric immunoassay technique every other days. The results were as followed; 1. There were no statistically significant difference in clinical characteristics such as maternal age, parity, abortion, gestational age at admission. 2. C-reactive protein level was significant as an indicator of subclinical intrauterine infection in preterm labor by the comparison of the control group(P$lt;0.01). 3. There were statistically significant differences in mean time from start of labor to delivery and body weight at birth(P$lt;0.05), but no difference in gestational age at delivery, Apgar score, success rate to tocolytic therapy, term or preterm by the C-reactive protein on admission. 4. There were statistically significant differences in mean time from start of labor to delivery and gestational age at delivery, body weight at birth, gestational age at delivery, Apgar score, success rate to tocolytic therapy term or preterm by the C-reactive protein on 2 days after admission(P$lt;0.05, P$lt;0.01, P$lt;0.01, P$lt;0.05, P$lt;0.01, P$lt;0.05). 5. There were statistically significant differences in mean time from start of labor to delivery and success rate to tocolytic therapy, term or preterm(P$lt;0.05, P$lt;0.01, P$lt;0.05), but no difference in gestational age at delivery, body weight at birth, Apgar score by the C-reactive protein on 4 days after admission. C-reactive protein values indicate that it may become possible to predict the sucess or failure of tocolytic therapy in preterm labor by follow up every other days than single CRP measurement. We recommend in cases of preterm labor with high CRP levels or in cases where b sympathomimetic agents fail to stop preterm uterine contraction, that the presence of infection as contributing factor should be suspected, even in the absence of any clinical maniifestation of the infectious process.

중복기형아 1 예

이승호,정원영,고민환,김재웅,김기득 대한산부인과학회 1991 Obstetrics & Gynecology Science Vol.34 No.2

저자들은 영남대학교 의과대학 산부인과학교실에서 복부와 하지가 중복된 기형 1례를 경험하였기에 간단한 문헌고찰과 함께 보고하는 바이다. Conjoined twins are known to be extremely rare but the earliest conjoined twins were reported in 1100 A.D. It has various anatomical unions and its etiology was still unknown. It can be diagnosed prenatally by ultrasonic imaging. We report a case of conjoined twins didelphus dipus tetrabrachius with brief review for literatures.